title: Laparoscopic approach in complicated diverticular disease.
abstract: OBJECTIVE
  To analyze the results of laparoscopic colectomy in complicated diverticular disease.
  
  
  METHODS
  This was a retrospective cohort study conducted at an academic teaching hospital. Data were collected from a database established earlier, which comprise of all patients who underwent laparoscopic colectomy for diverticular disease between 2000 and 2013. The series was divided into two groups that were compared: Patients with complicated disease (abscess, perforation, fistula, or stenosis) (G1) and patients undergoing surgery for recurrent diverticulitis (G2). Recurrent diverticulitis was defined as two or more episodes of diverticulitis regardless of patient age. Data regarding patient demographics, comorbidities, prior abdominal operations, history of acute diverticulitis, classification of acute diverticulitis at index admission and intra and postoperative variables were extracted. Univariate analysis was performed in both groups.
  
  
  RESULTS
  Two hundred and sixty patients were included: 28% (72 patients) belonged to G1 and 72% (188 patients) to G2. The mean age was 57 (27-89) years. The average number of episodes of diverticulitis before surgery was 2.1 (r 0-10); 43 patients had no previous inflammatory pathology. There were significant differences between the two groups with respect to conversion rate and hospital stay (G1 18% vs G2 3.2%, P = 0.001; G1: 4.7 d vs G2 3.3 d, P < 0.001). The anastomotic dehiscence rate was 2.3%, with no statistical difference between the groups (G1 2.7% vs G2 2.1%, P = 0.5). There were no differences in demographic data (body mass index, American Society of Anesthesiology and previous abdominal surgery), operative time and intraoperative and postoperative complications between the groups. The mortality rate was 0.38% (1 patient), represented by a death secondary to septic shock in G2.
  
  
  CONCLUSIONS
  The results support that the laparoscopic approach in any kind of complicated diverticular disease can be performed with low morbidity and acceptable conversion rates when compared with patients undergoing laparoscopic surgery for recurrent diverticulitis.
authors.affiliation: Nicolás A Rotholtz, Alejandro G Canelas, Maximiliano E Bun, Mariano Laporte, Emmanuel E Sadava, Natalia Ferrentino, Sebastián A Guckenheimer, Department of Surgery, Hospital Alemán, Buenos Aires C1118AAT, Argentina.
authors.forename: Nicolás A
authors.initials: NA
authors.lastname: Rotholtz
authors.affiliation: Nicolás A Rotholtz, Alejandro G Canelas, Maximiliano E Bun, Mariano Laporte, Emmanuel E Sadava, Natalia Ferrentino, Sebastián A Guckenheimer, Department of Surgery, Hospital Alemán, Buenos Aires C1118AAT, Argentina.
authors.forename: Alejandro G
authors.initials: AG
authors.lastname: Canelas
authors.affiliation: Nicolás A Rotholtz, Alejandro G Canelas, Maximiliano E Bun, Mariano Laporte, Emmanuel E Sadava, Natalia Ferrentino, Sebastián A Guckenheimer, Department of Surgery, Hospital Alemán, Buenos Aires C1118AAT, Argentina.
authors.forename: Maximiliano E
authors.initials: ME
authors.lastname: Bun
authors.affiliation: Nicolás A Rotholtz, Alejandro G Canelas, Maximiliano E Bun, Mariano Laporte, Emmanuel E Sadava, Natalia Ferrentino, Sebastián A Guckenheimer, Department of Surgery, Hospital Alemán, Buenos Aires C1118AAT, Argentina.
authors.forename: Mariano
authors.initials: M
authors.lastname: Laporte
authors.affiliation: Nicolás A Rotholtz, Alejandro G Canelas, Maximiliano E Bun, Mariano Laporte, Emmanuel E Sadava, Natalia Ferrentino, Sebastián A Guckenheimer, Department of Surgery, Hospital Alemán, Buenos Aires C1118AAT, Argentina.
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Sadava
authors.affiliation: Nicolás A Rotholtz, Alejandro G Canelas, Maximiliano E Bun, Mariano Laporte, Emmanuel E Sadava, Natalia Ferrentino, Sebastián A Guckenheimer, Department of Surgery, Hospital Alemán, Buenos Aires C1118AAT, Argentina.
authors.forename: Natalia
authors.initials: N
authors.lastname: Ferrentino
authors.affiliation: Nicolás A Rotholtz, Alejandro G Canelas, Maximiliano E Bun, Mariano Laporte, Emmanuel E Sadava, Natalia Ferrentino, Sebastián A Guckenheimer, Department of Surgery, Hospital Alemán, Buenos Aires C1118AAT, Argentina.
authors.forename: Sebastián A
authors.initials: SA
authors.lastname: Guckenheimer
keywords: Complicated diverticulitis; Laparoscopy; Outcomes; Recurrent diverticulitis; Sigmoid colectomy