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Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? A systematic review.
Int J Surg. 2015 Dec; 24(Pt A):95-100.IJ

Abstract

INTRODUCTION

Laparoscopic surgery is considered in the treatment of diverticular fistula for the possible reduction of overall morbidity and complication rate if compared to open surgery. Aim of this review is to assess the possible advantages deriving from a laparoscopic approach in the treatment of diverticular fistulas of the colon.

METHODS

Studies presenting at least 10 adult patients who underwent laparoscopic surgery for sigmoid diverticular fistula were reviewed. Fistula recurrence, reintervention, Hartmann's procedure or proximal diversion, conversion to laparotomy were the outcomes considered.

RESULTS

11 non randomized studies were included. Rates of fistula recurrence (0.8%), early reintervention (30 days) (2%) and need for Hartmann's procedure or proximal diversion (1.4%) did not show significant difference between laparoscopy and open technique.

DISCUSSION

there is still concern about which surgery in complicated diverticulitis should be preferred. Laparoscopic approach has led to less postoperative pain, shorter hospital stay, faster recovery and better cosmetic results. Laparoscopic resection and primary anastomosis is a possible approach to sigmoid fistulas but its advantages in terms of lower mortality rate and postoperative stay after colon resection with primary anastomosis should be interpreted with caution. When there is firm evidence supporting it, it is likely that minimally invasive surgery should become the standard approach for diverticular fistulas, thus achieving adequate exposure and better visualization of the surgical field.

CONCLUSION

The lack of RCTs, the small sample size, the heterogeneity of literature do not allow to draw statistically significant conclusions on the laparoscopic surgery for fistulas despite this approach is considered safe.

Authors+Show Affiliations

Department of Digestive Surgery and Liver Unit, University of Perugai, St Maria Hospital, Viale Tristano di Joannuccio, 1, 05100 Terni, Italy. Electronic address: cirocchiroberto@yahoo.it.Department of Surgical Sciences, University of Turin, C.So Dogliotti, 38, 10126 Torino, Italy. Electronic address: alberto.arezzo@unito.it.Department of General and Oncologic Surgery, University of Perugia, S. Andrea delle Fratte, Piazzale Menghini, 1, 06157 Perugia, Italy. Electronic address: renzicla@virgilio.it.Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Viale Tristano di Joannuccio, 1, 05100 Terni, Italy. Electronic address: giovannicochetti@libero.it.Department of Surgical Sciences, 'Sapienza' University of Rome, Viale Regina Elena 324, 00185 Rome, Italy. Electronic address: vito.dandrea@uniroma1.it.Section for Surgical Research (Prof Uranues), Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria. Electronic address: abefingerhut@aol.com.Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Viale Tristano di Joannuccio, 1, 05100 Terni, Italy. Electronic address: ettore.mearini@unipg.it.Department of General Surgery, Galliera Hospital, Mura Delle Cappuccine, 14, 16128 Genoa, Italy. Electronic address: gian.andrea.binda@galliera.it.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

26584958

Citation

Cirocchi, Roberto, et al. "Is Laparoscopic Surgery the Best Treatment in Fistulas Complicating Diverticular Disease of the Sigmoid Colon? a Systematic Review." International Journal of Surgery (London, England), vol. 24, no. Pt A, 2015, pp. 95-100.
Cirocchi R, Arezzo A, Renzi C, et al. Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? A systematic review. Int J Surg. 2015;24(Pt A):95-100.
Cirocchi, R., Arezzo, A., Renzi, C., Cochetti, G., D'Andrea, V., Fingerhut, A., Mearini, E., & Binda, G. A. (2015). Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? A systematic review. International Journal of Surgery (London, England), 24(Pt A), 95-100. https://doi.org/10.1016/j.ijsu.2015.11.007
Cirocchi R, et al. Is Laparoscopic Surgery the Best Treatment in Fistulas Complicating Diverticular Disease of the Sigmoid Colon? a Systematic Review. Int J Surg. 2015;24(Pt A):95-100. PubMed PMID: 26584958.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? A systematic review. AU - Cirocchi,Roberto, AU - Arezzo,Alberto, AU - Renzi,Claudio, AU - Cochetti,Giovanni, AU - D'Andrea,Vito, AU - Fingerhut,Abe, AU - Mearini,Ettore, AU - Binda,Gian Andrea, Y1 - 2015/11/14/ PY - 2015/5/4/received PY - 2015/11/1/revised PY - 2015/11/5/accepted PY - 2015/11/21/entrez PY - 2015/11/21/pubmed PY - 2016/7/29/medline KW - Bladder KW - Colon KW - Diverticular fistula KW - Diverticulitis KW - Laparoscopic surgery SP - 95 EP - 100 JF - International journal of surgery (London, England) JO - Int J Surg VL - 24 IS - Pt A N2 - INTRODUCTION: Laparoscopic surgery is considered in the treatment of diverticular fistula for the possible reduction of overall morbidity and complication rate if compared to open surgery. Aim of this review is to assess the possible advantages deriving from a laparoscopic approach in the treatment of diverticular fistulas of the colon. METHODS: Studies presenting at least 10 adult patients who underwent laparoscopic surgery for sigmoid diverticular fistula were reviewed. Fistula recurrence, reintervention, Hartmann's procedure or proximal diversion, conversion to laparotomy were the outcomes considered. RESULTS: 11 non randomized studies were included. Rates of fistula recurrence (0.8%), early reintervention (30 days) (2%) and need for Hartmann's procedure or proximal diversion (1.4%) did not show significant difference between laparoscopy and open technique. DISCUSSION: there is still concern about which surgery in complicated diverticulitis should be preferred. Laparoscopic approach has led to less postoperative pain, shorter hospital stay, faster recovery and better cosmetic results. Laparoscopic resection and primary anastomosis is a possible approach to sigmoid fistulas but its advantages in terms of lower mortality rate and postoperative stay after colon resection with primary anastomosis should be interpreted with caution. When there is firm evidence supporting it, it is likely that minimally invasive surgery should become the standard approach for diverticular fistulas, thus achieving adequate exposure and better visualization of the surgical field. CONCLUSION: The lack of RCTs, the small sample size, the heterogeneity of literature do not allow to draw statistically significant conclusions on the laparoscopic surgery for fistulas despite this approach is considered safe. SN - 1743-9159 UR - https://www.unboundmedicine.com/medline/citation/26584958/Is_laparoscopic_surgery_the_best_treatment_in_fistulas_complicating_diverticular_disease_of_the_sigmoid_colon_A_systematic_review_ DB - PRIME DP - Unbound Medicine ER -