Laparoscopic sigmoid colectomy for complicated diverticulitis is safe: review of 576 consecutive colectomies.
BACKGROUND
Laparoscopic resection of diverticular disease is typically offered to selected patients. We present the outcomes of laparoscopic colectomy in consecutive patients suffering from either simple diverticulitis (SD) or complicated diverticulitis (CD).


OBJECTIVE
To examine the outcomes of laparoscopic sigmoid colectomy for complicated diverticulitis.


METHODS
Between December 2001 and May 2013, all patients with diverticulitis requiring elective operation were offered laparoscopic sigmoid colectomy as the initial approach. All cases were managed at a large tertiary care center on the colorectal surgery service. Preoperative, intraoperative, and postoperative variables were prospectively entered into the colorectal surgery service database (CRSD) and analyzed retrospectively.


RESULTS
Of the 576 patients in the CRSD, 139 (24.1%) had CD. The overall conversion rate was 12.8% (n = 74). The average BMI was 29.8 kg/m(2). The conversion rate for CD was 12.2%. The return of bowel function time was delayed in the CD group when compared to the SD group (3.1 vs 3.8 days, p = 0.04). The hospital length of stay (HLOS) was similar between the groups (5.1 vs 5.8 days, p = 0.08). The overall anastomotic leak rate was 2.1% (n = 12). Patients undergoing laparoscopic resection for SD had a postoperative complication rate of 10.0% (n = 38), whereas those with CD had a postoperative morbidity rate of 19.6% (n = 24). CD patients who had conversion to an open procedure had an even higher rate of postoperative complications (29.4%, n = 5, p = 0.35). On non-parsimonious multivariate adjustment, only CD (RR 1.96, 95% CI 1.11-3.46, p = 0.02) was found to be an independent risk factor for the development of postoperative complications.


CONCLUSIONS
Complicated diverticulitis did not affect the conversion rate to an open procedure. However, patients with CD are prone to postoperative complications. The laparoscopic approach to sigmoid colectomy is safe and preferable in experienced hands.
Department of Surgery, Albany Medical College, 43 New Scotland Avenue, Mail Code MC-194, Albany, NY, 12208-3479, USA. bhaktaa@mail.amc.edu.
Avinash
A
Bhakta
Department of Surgery, Albany Medical College, 43 New Scotland Avenue, Mail Code MC-194, Albany, NY, 12208-3479, USA.
Marcel
M
Tafen
Department of Surgery, Albany Medical College, 43 New Scotland Avenue, Mail Code MC-194, Albany, NY, 12208-3479, USA.
Owen
O
Glotzer
Department of Surgery, Albany Medical College, 43 New Scotland Avenue, Mail Code MC-194, Albany, NY, 12208-3479, USA.
Jonathan
J
Canete
Department of Surgery, Albany Medical College, 43 New Scotland Avenue, Mail Code MC-194, Albany, NY, 12208-3479, USA.
A David
AD
Chismark
Department of Surgery, Albany Medical College, 43 New Scotland Avenue, Mail Code MC-194, Albany, NY, 12208-3479, USA.
Brian T
BT
Valerian
Department of Surgery, Albany Medical College, 43 New Scotland Avenue, Mail Code MC-194, Albany, NY, 12208-3479, USA.
Steven C
SC
Stain
Department of Surgery, Albany Medical College, 43 New Scotland Avenue, Mail Code MC-194, Albany, NY, 12208-3479, USA.
Edward C
EC
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D012809:Colon, Sigmoid / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D004240:Diverticulum / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
Bowel; Colectomy; Colorectal; Colo…; Diverticulitis; Gut; Laparoscopic; Sigmoid