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Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis.
Dis Colon Rectum. 2000 Dec; 43(12):1726-31.DC

Abstract

PURPOSE

The purpose of this study was to evaluate the safety and efficacy of laparoscopic-assisted sigmoid colectomy for the treatment of diverticulitis.

METHODS

The Norfolk Surgical Group Laparoscopic Surgery Registry identified all patients undergoing laparoscopic colon and rectal surgery. Retrospective chart review was performed for all patients undergoing elective sigmoid resection for a final diagnosis of diverticulitis and minimum follow-up of 12 months. Demographic data, indications for surgery, operative data, conversion rate, reason for conversion, complications, postoperative course (days to flatus and regular diet), and length of stay were identified. A telephone survey determined the incidence of recurrent diverticulitis. Statistical analysis was performed to evaluate the frequency of conversion over time, to determine risk factors for conversion, and to compare the laparoscopic-assisted and conversion groups with regard to postoperative days to flatus, regular diet, and discharge.

RESULTS

From June 1992 to September 1997, elective laparoscopic-assisted sigmoid colectomy was attempted in 69 patients. Uncomplicated recurrent diverticulitis was the most common indication for surgery, occurring in 51 of 69 patients (75 percent). No deaths occurred. Complications were identified in seven patients (10.1 percent) including one wound infection and one incarcerated port-site hernia with small bowel obstruction. There were no anastomotic leaks or major septic complications. Conversion to laparotomy occurred in 18 of 69 patients (26 percent). Uncomplicated, recurrent diverticulitis was associated with conversion in 7 of 51 patients (14 percent), whereas complicated diverticulitis required conversion in 11 of 18 patients (61 percent). Logistic regression identified fistula and abscess as predictors of conversion (P = 0.0009). Comparison of the laparoscopic-assisted sigmoid colectomy group with the conversion group revealed that postoperative days to regular diet were 3.5 and 5.2 (P = 0.0004), respectively, and lengths of stay were 4.2 and 6.4 days (P < 0.0001), respectively. No difference was noted with regard to operative time or postoperative complications. Median follow-up was 48 (range, 13-76) months, and a single recurrence of diverticulitis has been identified.

CONCLUSIONS

Laparoscopic-assisted sigmoid colectomy for diverticulitis can be safely performed. Conversion appears to be associated with complicated diverticulitis (fistula or abscess), which may be better approached by laparotomy. Short-term follow-up indicates that recurrence is rare and suggests that laparoscopic-assisted sigmoid colectomy achieves adequate resection. Laparoscopic-assisted sigmoid colectomy offers benefits of decreased ileus and length of stay and may represent the procedure of choice for elective resection for uncomplicated sigmoid diverticulitis.

Authors+Show Affiliations

Norfolk Surgical Group, Ltd., and the Department of Surgery, Eastern Virginia Medical School, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

11156458

Citation

Vargas, H D., et al. "Defining the Role of Laparoscopic-assisted Sigmoid Colectomy for Diverticulitis." Diseases of the Colon and Rectum, vol. 43, no. 12, 2000, pp. 1726-31.
Vargas HD, Ramirez RT, Hoffman GC, et al. Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis. Dis Colon Rectum. 2000;43(12):1726-31.
Vargas, H. D., Ramirez, R. T., Hoffman, G. C., Hubbard, G. W., Gould, R. J., Wohlgemuth, S. D., Ruffin, W. K., Hatter, J. E., & Kolm, P. (2000). Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis. Diseases of the Colon and Rectum, 43(12), 1726-31.
Vargas HD, et al. Defining the Role of Laparoscopic-assisted Sigmoid Colectomy for Diverticulitis. Dis Colon Rectum. 2000;43(12):1726-31. PubMed PMID: 11156458.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis. AU - Vargas,H D, AU - Ramirez,R T, AU - Hoffman,G C, AU - Hubbard,G W, AU - Gould,R J, AU - Wohlgemuth,S D, AU - Ruffin,W K, AU - Hatter,J E, AU - Kolm,P, PY - 2001/1/13/pubmed PY - 2001/2/28/medline PY - 2001/1/13/entrez SP - 1726 EP - 31 JF - Diseases of the colon and rectum JO - Dis Colon Rectum VL - 43 IS - 12 N2 - PURPOSE: The purpose of this study was to evaluate the safety and efficacy of laparoscopic-assisted sigmoid colectomy for the treatment of diverticulitis. METHODS: The Norfolk Surgical Group Laparoscopic Surgery Registry identified all patients undergoing laparoscopic colon and rectal surgery. Retrospective chart review was performed for all patients undergoing elective sigmoid resection for a final diagnosis of diverticulitis and minimum follow-up of 12 months. Demographic data, indications for surgery, operative data, conversion rate, reason for conversion, complications, postoperative course (days to flatus and regular diet), and length of stay were identified. A telephone survey determined the incidence of recurrent diverticulitis. Statistical analysis was performed to evaluate the frequency of conversion over time, to determine risk factors for conversion, and to compare the laparoscopic-assisted and conversion groups with regard to postoperative days to flatus, regular diet, and discharge. RESULTS: From June 1992 to September 1997, elective laparoscopic-assisted sigmoid colectomy was attempted in 69 patients. Uncomplicated recurrent diverticulitis was the most common indication for surgery, occurring in 51 of 69 patients (75 percent). No deaths occurred. Complications were identified in seven patients (10.1 percent) including one wound infection and one incarcerated port-site hernia with small bowel obstruction. There were no anastomotic leaks or major septic complications. Conversion to laparotomy occurred in 18 of 69 patients (26 percent). Uncomplicated, recurrent diverticulitis was associated with conversion in 7 of 51 patients (14 percent), whereas complicated diverticulitis required conversion in 11 of 18 patients (61 percent). Logistic regression identified fistula and abscess as predictors of conversion (P = 0.0009). Comparison of the laparoscopic-assisted sigmoid colectomy group with the conversion group revealed that postoperative days to regular diet were 3.5 and 5.2 (P = 0.0004), respectively, and lengths of stay were 4.2 and 6.4 days (P < 0.0001), respectively. No difference was noted with regard to operative time or postoperative complications. Median follow-up was 48 (range, 13-76) months, and a single recurrence of diverticulitis has been identified. CONCLUSIONS: Laparoscopic-assisted sigmoid colectomy for diverticulitis can be safely performed. Conversion appears to be associated with complicated diverticulitis (fistula or abscess), which may be better approached by laparotomy. Short-term follow-up indicates that recurrence is rare and suggests that laparoscopic-assisted sigmoid colectomy achieves adequate resection. Laparoscopic-assisted sigmoid colectomy offers benefits of decreased ileus and length of stay and may represent the procedure of choice for elective resection for uncomplicated sigmoid diverticulitis. SN - 0012-3706 UR - https://www.unboundmedicine.com/medline/citation/11156458/Defining_the_role_of_laparoscopic_assisted_sigmoid_colectomy_for_diverticulitis_ L2 - http://link.springer.com/article/10.1007/BF02236858 DB - PRIME DP - Unbound Medicine ER -