title: Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort.
abstract: Hartmann's procedure for perforated diverticulitis can be characterised by high morbidity and mortality rates. While the scientific community focuses on laparoscopic lavage as an alternative for laparotomy, the option of laparoscopic sigmoidectomy seems overlooked. We compared morbidity and hospital stay following acute laparoscopic sigmoidectomy (LS) and open sigmoidectomy (OS) for perforated diverticulitis.
  
  
  
  This retrospective cohort parallel to the Ladies trial included patients from 28 Dutch academic or teaching hospitals between July 2010 and July 2014. Patients with LS were matched 1:2 to OS using the propensity score for age, gender, previous laparotomy, CRP level, gastrointestinal surgeon, and Hinchey classification.
  
  
  
  The propensity-matched cohort consisted of 39 patients with LS and 78 patients with OS, selected from a sample of 307 consecutive patients with purulent or faecal perforated diverticulitis. In both groups, 66 % of the patients had Hartmann's procedure and 34 % had primary anastomosis. The hospital stay was shorter following LS (LS 7 vs OS 9 days; P = 0.016), and the postoperative morbidity rate was lower following LS (LS 44 % vs OS 66 %; P = 0.016). Mortality was low in both groups (LS 3 % vs OS 4 %; P = 0.685). The stoma reversal rate after Hartmann's procedure was higher following laparoscopy, with a probability of being stoma-free at 12 months of 88 and 62 % in the laparoscopic and open groups, respectively (P = 0.019). After primary anastomosis, the probability of reversal was 100 % in both groups.
  
  
  
  In this propensity score-matched cohort, laparoscopic sigmoidectomy is superior to open sigmoidectomy for perforated diverticulitis with regard to postoperative morbidity and hospital stay.
authors.affiliation: Department of Surgery, Academic Medical Center, Postbox 22660, 1100 DD, Amsterdam, The Netherlands. s.vennix@amc.nl.|Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands. s.vennix@amc.nl.
authors.forename: Sandra
authors.initials: S
authors.lastname: Vennix
authors.affiliation: Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lips
authors.affiliation: Department of Surgery, Hospital Maggiore, Bologna, Italy.
authors.forename: Salomone
authors.initials: S
authors.lastname: Di Saverio
authors.affiliation: Department of Surgery, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands.
authors.forename: Bart A
authors.initials: BA
authors.lastname: van Wagensveld
authors.affiliation: Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Brokelman
authors.affiliation: Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Gerhards
authors.affiliation: Department of Surgery, Tergooi Hospital, Hilversum, The Netherlands.
authors.forename: Anna A
authors.initials: AA
authors.lastname: van Geloven
authors.affiliation: Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Susan
authors.initials: S
authors.lastname: van Dieren
authors.affiliation: Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
authors.affiliation: Department of Surgery, Academic Medical Center, Postbox 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D015331:Cohort Studies; D012809:Colon, Sigmoid / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies
keywords: Diverticulitis; Laparoscopy; Perforated diverticulitis; Propensity score; Sigmoid resection