title: Preservation of the superior rectal artery: influence of surgical technique on anastomotic healing and postoperative morbidity in laparoscopic sigmoidectomy for diverticular disease.
abstract: OBJECTIVE
  To evaluate the impact of superior rectal artery (SRA) sparing technique on anastomotic leakage in laparoscopic sigmoidectomy for diverticular disease.
  
  
  METHODS
  A retrospective multicenter analysis of all patients undergoing laparoscopic sigmoid resection for diverticular disease between 2002 and 2015 was conducted. Data were recorded in three hospitals: University Hospital Regensburg, Marienhospital Gelsenkirchen, and Städtisches Klinikum München Bogenhausen. The SRA was resected between 2002 and 2005. Since 2005, the artery was preserved in most cases.
  
  
  RESULTS
  Two hundred sixty-seven patients were included. One hundred sixty patients presented with complicated diverticulitis (60%). The SRA was resected in 102 patients (group 1) and preserved in 157 patients (group 2, no data in eight cases). Anastomotic leakage occurred in 7% of patients in group 1 and 1.9% of patients in group 2 (p = 0.053). Duration of surgery was significantly shorter (157 vs. 183 min, p < 0.001) in group 2 patients. Length of hospital stay was without significant difference (group 1 8.2 days; group 2 8.3 days; p = 0.83). The conversion rate was higher in group 2 patients; however, the difference was not statistically significant (9 vs. 3%, p = 0.07). There was no significant difference between both groups regarding intraoperative complications and overall complication rate. The length of the resected specimen (19 vs. 21 cm, p = 0.001) was significantly shorter in group 2 patients.
  
  
  CONCLUSIONS
  Preservation of the SRA seems to be associated with favorable outcome in patients undergoing laparoscopic sigmoid resection for diverticular disease.
authors.affiliation: Department of General, Abdominal, Endocrine and Minimally Invasive Surgery, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Englschalkinger Strasse 77, 81925, Munich, Germany. maximilian.sohn@klinikum-muenchen.de.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Sohn
authors.affiliation: Department of Surgery, Universitätsklinikum Regensburg, Regensburg, Germany.
authors.forename: H J
authors.initials: HJ
authors.lastname: Schlitt
authors.affiliation: Department of Surgery, Universitätsklinikum Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hornung
authors.affiliation: Department for Surgery, Krankenhaus St. Marienwörth, Bad Kreuznach, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Zülke
authors.affiliation: OCM München, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hochrein
authors.affiliation: Department of General, Abdominal, Endocrine and Minimally Invasive Surgery, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Englschalkinger Strasse 77, 81925, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Moser
authors.affiliation: Department of General, Abdominal, Endocrine and Minimally Invasive Surgery, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Englschalkinger Strasse 77, 81925, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Agha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology*; D015331:Cohort Studies; D012809:Colon, Sigmoid / Q000601:surgery*; D003710:Demography; D000076385:Diverticular Diseases / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012007:Rectum / Q000098:blood supply* / Q000601:surgery*; D014945:Wound Healing; D055815:Young Adult
keywords: Diverticular disease; High tie; Laparoscopic sigmoidectomy; Low tie; Superior rectal artery