World Journal of Surgery

, Volume 34, Issue 12, pp 2883-2901

First online:

Elective Open versus Laparoscopic Sigmoid Colectomy for Diverticular Disease: A Meta-Analysis with the Sigma Trial

  • Muhammed R. S. SiddiquiAffiliated withDepartment of Colorectal Surgery, Worthing Hospital Email author 
  • , Muhammed S. SajidAffiliated withDepartment of Colorectal Surgery, Worthing Hospital
  • , Kamran KhatriAffiliated withDepartment of Colorectal Surgery, Worthing Hospital
  • , Elizabeth CheekAffiliated withDepartment of Colorectal Surgery, Worthing Hospital
  • , Mirza K. BaigAffiliated withDepartment of Colorectal Surgery, Worthing Hospital

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A meta-analysis of published literature comparing open versus laparoscopic elective sigmoid resections for diverticular disease was conducted.


Electronic databases were searched for data from January 1991 to March 2009. A systematic review was performed to obtain a summative outcome.


Twenty-two comparative studies involving 10,898 patients were analyzed; 1538 patients were in the laparoscopic group and 9360 were in the open group. The operative time for laparoscopic sigmoid resection (LSR) is longer than open resections (OSR) [random-effects model: SMD = 1.94, 95% CI = (1.14, 2.74), z = 4.74, p < 0.001]. However, patients who undergo LSR have earlier return to passage of feces [random-effects model: SMD = −1.01, 95% CI (−1.80, −0.22), z = −2.50, p = 0.013] and shorter hospital stay [random-effects model: SMD = −7.65, 95% CI (−10.96, −4.32), z = −4.52, p < 0.001]. Overall morbidity was higher in the OSR group [random-effects model: RR = 0.56, 95% CI (0.40, 0.80), z = −3.24, p < 0.001] and no difference in mortality rates was observed (p = 0.81).


Laparoscopic sigmoid resection takes longer to perform than open procedures; however, it is safe and has lower overall morbidity, earlier return of bowel function, and shorter hospital stays. This approach should be considered for elective cases but more randomized controlled trials are required to strengthen the evidence.