title: Surgical Treatment of Diverticulitis: Hand-Assisted Laparoscopic Resection Is Predominantly Used for Complex Cases and Is Associated With Increased Postoperative Complications and Prolonged Hospitalization.
abstract: Introduction Laparoscopic (LAP) colectomy is now the "gold" standard for diverticulitis; the role of hand-assisted LAP (HAL) and Open methods today is unclear. This study assessed the elective use of these methods for diverticulitis. Methods A retrospective review of demographic, comorbidity (Carlson Comorbidity Index [CCI]), resection type, and short-term outcomes was carried out. Results There were 125 (44.5%) LAP, 125 (44.5%) HAL, and 31 (11%) Open cases (overall N = 281). The mean age, body mass index, and percentage of high-risk patients (CCI score >2) of the HAL group were greater (P < .05) than the LAP group (vs Open, P = ns). The Open group's mean age and percent with CCI >2 was greater when compared with the LAP group (P < .05). More Open (P < .05) and HAL patients had complex disease (Open, 63%; HAL, 40%, LAP, 22%) and were diverted (Open, 35%; HAL, 10%; LAP, 3%). Time to bowel movement was not different; however, there was a stepwise increase in median length of stay (LOS; days) from the LAP (5 days) to HAL (6 days) to Open group (7 days) (P < .05 for all). The LAP complication rate (22.4%) was lower (P < .05) than the HAL (42.4%) or Open groups' (45.2%) rates. The LAP surgical site infection rate (5.6%) was lower (P < .05) than the HAL (12.8%) or Open groups (19.6%). Conclusion The HAL and Open groups had more high risk, complex disease, diverted, and older patients than the LAP group; likewise, the overall complication rate and LOS was higher in the HAL and Open groups. Use of HAL methods likely contributed to the high minimally invasive surgery utilization rate (89%).
authors.affiliation: Mount Sinai Roosevelt Hospital Center, New York, NY, USA Saiseikai Senri Hospital, Suita, Osaka, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Miyagaki
authors.affiliation: Mount Sinai Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Rhee
authors.affiliation: Mount Sinai Roosevelt Hospital Center, New York, NY, USA.
authors.forename: H M C
authors.initials: HM
authors.lastname: Shantha Kumara
authors.affiliation: Mount Sinai Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Yan
authors.affiliation: Mount Sinai Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Njoh
authors.affiliation: Mount Sinai Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Vesna
authors.initials: V
authors.lastname: Cekic
authors.affiliation: Mount Sinai Roosevelt Hospital Center, New York, NY, USA Icahn School of Medicine at Mount Sinai, New York, NY, USA rwhelan@chpnet.org.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Whelan
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D016208:Databases, Factual; D004238:Diverticulitis / Q000175:diagnosis / Q000601:surgery*; D004241:Diverticulum, Colon / Q000150:complications / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects* / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
keywords: colorectal surgery; surgical education; surgical oncology