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Laparoscopic sigmoid resections for diverticulitis complicated by abscesses or fistulas.
Int J Colorectal Dis. 2007 Dec; 22(12):1515-21.IJ

Abstract

BACKGROUND AND AIMS

Treatment of choice in recurrent and complicated diverticulitis is surgical resection of the inflamed bowel. Whereas it is accepted that recurrent diverticulitis (RD) can be handled laparoscopically, this is still not generally recommended for complicated diverticulitis (CD). Therefore, we analysed our results of laparoscopic sigmoidectomies concerning intraoperative course, conversion rate, morbidity and hospital stay in RD and CD.

MATERIALS AND METHODS

Between 09/2002 and 01/2006, laparoscopic sigmoidectomies were offered to all patients suffering from recurrent or complicated diverticulitis (Hinchey I+II). All resections were performed in a four-port technique with the use of Ultracision and intraabdominal stapler anastomosis. Data were prospectively collected and retrospectively analysed in an intention-to-treat view.

RESULTS

Out of 127 laparoscopic colectomies, 58 were performed for diverticulitis (RD 32; CD 26). Eight patients with colovesical and one patient with colovaginal fistula are included. Three patients with abscesses underwent pretreatment by percutaneous drainage. Operative time was longer in CD than in RD (205+/-41 vs 147+/-34 min; p<0.001) and associated with higher blood loss, but conversion rate was low (RD, 2/32 vs CD, 3/26; p=0.64). There was one intraoperative complication in each group; postoperative major complications occurred in 3.13% (RD) vs 11.5% (CD; p=0.316). One anastomotic leakage occurred in the RD group. Length of hospital stay was shorter for RD than for CD (7.1+/-3.4 vs 10.7+/-6.4 days; p=0.02).

CONCLUSIONS

Laparoscopic resections should not be limited to recurrent diverticular disease but can be safely applied for complicated diverticulitis.

Authors+Show Affiliations

Zapletal C
Department of Surgery, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany. christina.zapletal@kgu.de
Woeste G
No affiliation info available
Bechstein WO
No affiliation info available
Wullstein C
No affiliation info available

MeSH

AbscessAdultAgedAnastomosis, SurgicalBlood Loss, SurgicalColectomyColon, SigmoidDiverticulitis, ColonicFemaleHumansIntestinal FistulaLaparoscopyLength of StayMaleMiddle AgedPatient SelectionRecurrenceRetrospective StudiesSeverity of Illness IndexTime FactorsTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17646998

Citation

Zapletal, Christina, et al. "Laparoscopic Sigmoid Resections for Diverticulitis Complicated By Abscesses or Fistulas." International Journal of Colorectal Disease, vol. 22, no. 12, 2007, pp. 1515-21.
Zapletal C, Woeste G, Bechstein WO, et al. Laparoscopic sigmoid resections for diverticulitis complicated by abscesses or fistulas. Int J Colorectal Dis. 2007;22(12):1515-21.
Zapletal, C., Woeste, G., Bechstein, W. O., & Wullstein, C. (2007). Laparoscopic sigmoid resections for diverticulitis complicated by abscesses or fistulas. International Journal of Colorectal Disease, 22(12), 1515-21.
Zapletal C, et al. Laparoscopic Sigmoid Resections for Diverticulitis Complicated By Abscesses or Fistulas. Int J Colorectal Dis. 2007;22(12):1515-21. PubMed PMID: 17646998.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic sigmoid resections for diverticulitis complicated by abscesses or fistulas. AU - Zapletal,Christina, AU - Woeste,Guido, AU - Bechstein,Wolf O, AU - Wullstein,Christoph, Y1 - 2007/07/24/ PY - 2007/06/28/accepted PY - 2007/7/25/pubmed PY - 2008/1/26/medline PY - 2007/7/25/entrez SP - 1515 EP - 21 JF - International journal of colorectal disease JO - Int J Colorectal Dis VL - 22 IS - 12 N2 - BACKGROUND AND AIMS: Treatment of choice in recurrent and complicated diverticulitis is surgical resection of the inflamed bowel. Whereas it is accepted that recurrent diverticulitis (RD) can be handled laparoscopically, this is still not generally recommended for complicated diverticulitis (CD). Therefore, we analysed our results of laparoscopic sigmoidectomies concerning intraoperative course, conversion rate, morbidity and hospital stay in RD and CD. MATERIALS AND METHODS: Between 09/2002 and 01/2006, laparoscopic sigmoidectomies were offered to all patients suffering from recurrent or complicated diverticulitis (Hinchey I+II). All resections were performed in a four-port technique with the use of Ultracision and intraabdominal stapler anastomosis. Data were prospectively collected and retrospectively analysed in an intention-to-treat view. RESULTS: Out of 127 laparoscopic colectomies, 58 were performed for diverticulitis (RD 32; CD 26). Eight patients with colovesical and one patient with colovaginal fistula are included. Three patients with abscesses underwent pretreatment by percutaneous drainage. Operative time was longer in CD than in RD (205+/-41 vs 147+/-34 min; p<0.001) and associated with higher blood loss, but conversion rate was low (RD, 2/32 vs CD, 3/26; p=0.64). There was one intraoperative complication in each group; postoperative major complications occurred in 3.13% (RD) vs 11.5% (CD; p=0.316). One anastomotic leakage occurred in the RD group. Length of hospital stay was shorter for RD than for CD (7.1+/-3.4 vs 10.7+/-6.4 days; p=0.02). CONCLUSIONS: Laparoscopic resections should not be limited to recurrent diverticular disease but can be safely applied for complicated diverticulitis. SN - 0179-1958 UR - https://www.unboundmedicine.com/medline/citation/17646998/Laparoscopic_sigmoid_resections_for_diverticulitis_complicated_by_abscesses_or_fistulas_ L2 - https://doi.org/10.1007/s00384-007-0359-y DB - PRIME DP - Unbound Medicine ER -