Abstract
The clinical spectrum of diverticular disease varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications, such as perforation or bleeding. While the presence of diverticula is common, symptomatic diverticulitis is relatively uncommon, occurring in an estimated 10–30 % of patients. There is continued debate as to whether patients should undergo elective resection for diverticular disease and regarding the role of minimally invasive surgery. Since the first publication on laparoscopic colorectal procedures, the interest in minimally invasive surgery has kept growing. Laparoscopic sigmoid resection with restoration of continuity is currently the prevailing modality for treating acute and recurrent sigmoid diverticulitis. However, it still remains unclear whether laparoscopy should be recommended also for complicated sigmoid diverticulitis. The potential benefits of reduced pain and analgesic requirements, smaller scars, and shorter hospital stay but longer operative times are appealing to both patients and surgeons. Nevertheless, there many concerns regarding the time and the type of surgery. Although the role of minimally invasive surgery in the treatment of colonic diseases is progressively increased, current randomized controlled trials should demonstrate whether laparoscopic lavage, Hartmann’s procedure or resection and anastomosis achieve the best results for patients. This review aimed to analyze the results of laparoscopic colonic resection for patients with uncomplicated and complicated forms of sigmoid diverticular disease and to determine what stages profit from a laparoscopic procedure and whether the approach can be performed with a low complication rate even for patients with complicated forms of the disease.
Similar content being viewed by others
References
Wong WD, Wexner SD, Lowry A, Vernava A 3rd, Burnstein M, Denstman F, Fazio V, Kerner B, Moore R, Oliver G, Peters W, Ross T, Senatore P, Simmang C, The American Society of Colon and Rectal Surgeons (2000) Practice parameters for the treatment of sigmoid diverticulitis supporting documentation: the standards task force. Dis Colon Rectum 43:290–297
Masoomi H, Buchberg BS, Magno C, Mills SD, Stamos MJ (2011) Trends in diverticulitis management in the United States from 2002 to 2007. Arch Surg 146:400–406. doi:10.1001/archsurg.2010.276
Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150
Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Engel AF, Cuesta MA (2009) Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma trial. Ann Surg 249:39–44. doi:10.1097/SLA.0b013e31818e416a
Siddiqui MR, Sajid MS, Qureshi S, Cheek E, Baig MK (2010) Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis. Am J Surg 200:144–161. doi:10.1016/j.amjsurg.2009.08.021
Jones OM, Stevenson AR, Clark D, Stitz RW, Lumley JW (2008) Laparoscopic resection for diverticular disease: follow-up of 500 consecutive patients. Ann Surg 248:1092–1097. doi:10.1097/SLA.0b013e3181884923
Senagore AJ, Duepree HJ, Delaney CP, Dissanaike S, Brady KM, Fazio VW (2002) Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease: similarities and differences. Dis Colon Rectum 45:485–490
Dwivedi A, Chahin F, Agrawal S, Chau WY, Tootla A, Tootla F, Silva YJ (2002) Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease. Dis Colon Rectum 45:1309–1314
Lehmann RK, Brounts LR, Johnson EK, Rizzo JA, Steele SR (2011) Does sacrifice of the inferior mesenteric artery or superior rectal artery affect anastomotic leak following sigmoidectomy for diverticulitis? A retrospective review. Am J Surg 201:623–627. doi:10.1016/j.amjsurg.2011.01.011
Cirocchi R, Trastulli S, Farinella E, Desiderio J, Listorti C, Parisi A, Noya G, Boselli C (2012) Is inferior mesenteric artery ligation during sigmoid colectomy for diverticular disease associated with increased anastomotic leakage? A meta-analysis of randomized and non-randomized clinical trials. Colorectal Dis 14:e521–e529. doi:10.1111/j.1463-1318.2012.03103.x
Masoni L, Mari FS, Nigri G, Favi F, Gasparrini M, Dall’Oglio A, Pindozzi F, Pancaldi A, Brescia A (2013) Preservation of the inferior mesenteric artery via laparoscopic sigmoid colectomy performed for diverticular disease: real benefit or technical challenge: a randomized controlled clinical trial. Surg Endosc 27:199–206. doi:10.1007/s00464-012-2420-3
Tocchi A, Mazzoni G, Fornasari V, Miccini M, Daddi G, Tagliacozzo S (2001) Preservation of the inferior mesenteric artery in colorectal resection for complicated diverticular disease. Am J Surg 182:162–167
Thaler K, Weiss EG, Nogueras JJ, Arnaud JP, Wexner SD, Bergamaschi R (2003) Recurrence rates at minimum 5-year follow-up: laparoscopic versus open sigmoid resection for uncomplicated diverticulitis. Surg Laparosc Endosc Percutan Tech 13:325–327
Benn PL, Wolff BG, Ilstrup DM (1986) Level of anastomosis and recurrent colonic diverticulitis. Am J Surg 151:269–271
Rafferty J, Shellito P, Hyman NH, Buie WD (2006) Standards Committee of American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 49:939–944
Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Engel AF, Cuesta MA (2009) Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma trial. Ann Surg 249:39–44. doi:10.1097/SLA.0b013e31818e416a
Klarenbeek BR, Bergamaschi R, Veenhof AA, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Cuesta MA (2011) Laparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control Sigma trial. Surg Endosc 25:1121–1126. doi:10.1007/s00464-010-1327-0
Klarenbeek BR, Coupe VM, van der Peet DL, Cuesta MA (2011) The cost effectiveness of elective laparoscopic sigmoid resection for symptomatic diverticular disease: financial outcome of the randomized control Sigma trial. Surg Endosc 25:776–783. doi:10.1007/s00464-010-1252-2
Gervaz P, Inan I, Perneger T, Schiffer E, Morel P (2010) A prospective, randomized, single-blind comparison of laparoscopic versus open sigmoid colectomy for diverticulitis. Ann Surg 252:3–8. doi:10.1097/SLA.0b013e3181dbb5a5
Forgione A, Leroy J, Cahill RA, Bailey C, Simone M, Mutter D, Marescaux J (2009) Prospective evaluation of functional outcome after laparoscopic sigmoid colectomy. Ann Surg 249:218–224. doi:10.1097/SLA.0b013e318195c5fc
Barry BD, Leroy J, Mutter D, Marescaux J (2012) Minimally invasive surgical treatment of sigmoid diverticulitis. Langenbeck Arch Surg 397:1035–1041. doi:10.1007/s00423-012-0965-1
Hinchey EJ, Schaal PG, Richards GK (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109
Franklin ME Jr, Dorman JP, Jacobs M, Plasencia G (1997) Is laparoscopic surgery applicable to complicated colonic diverticular disease? Surg Endosc 11:1021–1025
Wexner SD, Moscovitz ID (2000) Laparoscopic colectomy in diverticular and Crohn’s disease. Surg Clin North Am 80:1299–1319
Jacobs DO (2007) Clinical practice. Diverticulitis. N Engl J Med 357:2057–2066
Gaertner WB, Willis DJ, Madoff RD, Rothenberger DA, Kwaan MR, Belzer GE, Melton GB (2013) Percutaneous drainage of colonic diverticular abscess: is colon resection necessary? Dis Colon Rectum 56:622–626. doi:10.1097/DCR.0b013e31828545e3
Anaya DA, Flum DR (2005) Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surg 140:681–685
Rafferty J, Shellito P, Hyman NH, Buie WD (2006) Standards Committee of American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 49:939–944
Ambrosetti P, Chautems R, Soravia C, Peiris-Waser N, Terrier F (2005) Long-term outcome of mesocolic and pelvic diverticular abscesses of the left colon: a prospective study of 73 cases. Dis Colon Rectum 48:787–791
Zapletal C, Woeste G, Bechstein WO, Wullstein C (2007) Laparoscopic sigmoid resections for diverticulitis complicated by abscesses or fistulas. Int J Colorectal Dis 22:1515–1521
Hassan I, Cima RR, Larson DW, Dozois EJ, O’Byrne MM, Larson DR, Pemberton JH (2007) The impact of uncomplicated and complicated diverticulitis on laparoscopic surgery conversion rates and patient outcomes. Surg Endosc 21:1690–1694
Pendlimari R, Touzios JG, Azodo IA, Chua HK, Dozois EJ, Cima RR, Larson DW (2011) Short-term outcomes after elective minimally invasive colectomy for diverticulitis. Br J Surg 98:431–435. doi:10.1002/bjs.7345
Köckerling F, Schneider C, Reymond MA, Scheidbach H, Scheuerlein H, Konradt J, Bruch HP, Zornig C, Köhler L, Bärlehner E, Kuthe A, Szinicz G, Richter HA, Hohenberger W (1999) Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group. Surg Endosc 13:567–571
Schwandner O, Farke S, Fischer F, Eckmann C, Schiedeck TH, Bruch HP (2004) Laparoscopic colectomy for recurrent and complicated diverticulitis: a prospective study of 396 patients. Langenbeck Arch Surg 389:97–103
Pugliese R, Di Lernia S, Sansonna F, Scandroglio I, Maggioni D, Ferrari C, Costanzi A, Chiara O (2004) Laparoscopic treatment of sigmoid diverticulitis: a retrospective review of 103 cases. Surg Endosc 18:1344–1348
Katsuno G, Fukunaga M, Nagakari K, Yoshikawa S (2011) Laparoscopic one-stage resection of right and left colon complicated diverticulitis equivalent to Hinchey stage I–II. Surg Today 41:647–654. doi:10.1007/s00595-010-4349-2
Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Engel AF, Cuesta MA (2009) Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma trial. Ann Surg 249:39–44. doi:10.1097/SLA.0b013e31818e416a
Raue W, Paolucci V, Asperger W, Albrecht R, Büchler MW, Schwenk W (2011) LAPDIV-CAMIC Trial Group. Laparoscopic sigmoid resection for diverticular disease has no advantages over open approach: midterm results of a randomized controlled trial. Langenbeck Arch Surg 396:973–980. doi:10.1007/s00423-011-0825-4
Mayo WJ, Wilson LB, Griffin HZ (1907) Acquired diverticulitis of the large intestine. Surg Gynaecol Obstet 5:8–15
Hartmann H (1923) Note sur un procédé nouveau d’extirpation des cancers de la partie terminale du colôn. Bull Mem Soc Chir Paris 49:1474–1477
Greif JM, Fried G, McSherry CK (1980) Surgical treatment of perforated diverticulitis of the sigmoid colon. Dis Colon Rectum 23:483–487
Krukowski ZH, Matheson NA (1984) Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: a review. Br J Surg 71:921–927
Constantinides VA, Heriot A, Remzi F, Darzi A, Senapati A, Fazio VW, Tekkis PP (2007) Operative strategies for diverticular peritonitis: a decision analysis between primary resection and anastomosis versus Hartmann’s procedures. Ann Surg 245:94–103
Schilling MK, Maurer CA, Kollmar O, Büchler MW (2001) Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV): a prospective outcome and cost analysis. Dis Colon Rectum 44:699–703
Gooszen AW, Tollenaar RA, Geelkerken RH, Smeets HJ, Bemelman WA, Van Schaardenburgh P, Gooszen HG (2001) Prospective study of primary anastomosis following sigmoid resection for suspected acute complicated diverticular disease. Br J Surg 88:693–697
Salem L, Flum DR (2004) Primary anastomosis or Hartmann’s procedure for patients with diverticular peritonitis? A systematic review. Dis Colon Rectum 47:1953–1964
Abbas S (2007) Resection and primary anastomosis in acute complicated diverticulitis, a systematic review of the literature. Int J Colorectal Dis 22:351–357
Oberkofler CE, Rickenbacher A, Raptis DA, Lehmann K, Villiger P, Buchli C, Grieder F, Gelpke H, Decurtins M, Tempia-Caliera AA, Demartines N, Hahnloser D, Clavien PA, Breitenstein S (2012) A multicenter randomized clinical trial of primary anastomosis or Hartmann’s procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg 256:819–826. doi:10.1097/SLA.0b013e31827324ba
Chouillard E, Maggiori L, Ata T, Jarbaoui S, Rivkine E, Benhaim L, Ghiles E, Etienne JC, Fingerhut A (2007) Laparoscopic two-stage left colonic resection for patients with peritonitis caused by acute diverticulitis. Dis Colon Rectum 50:1157–1163
Agaba EA, Zaidi RM, Ramzy P, Aftab M, Rubach E, Gecelter G, Ravikumar TS, DeNoto G (2009) Laparoscopic Hartmann’s procedure: a viable option for treatment of acutely perforated diverticultis. Surg Endosc 23:1483–1486. doi:10.1007/s00464-009-0380-z
Rea JD, Herzig DO, Diggs BS, Cone MM, Lu KC (2012) Use and outcomes of emergent laparoscopic resection for acute diverticulitis. Am J Surg 203:639–643. doi:10.1016/j.amjsurg.2012.01.004
Turley RS, Barbas AS, Lidsky ME, Mantyh CR, Migaly J, Scarborough JE (2013) Laparoscopic versus open Hartmann procedure for the emergency treatment of diverticulitis: a propensity-matched analysis. Dis Colon Rectum 56:72–82. doi:10.1097/DCR.0b013e3182749cf5
Mbadiwe T, Obirieze AC, Cornwell EE 3rd, Turner P, Fullum TM (2013) Surgical management of complicated diverticulitis: a comparison of the laparoscopic and open approaches. J Am Coll Surg 216:782–788. doi:10.1016/j.jamcollsurg.2013.02.003
O’Sullivan GC, Murphy D, O’Brien MG, Ireland A (1996) Laparoscopic management of generalized peritonitis due to perforated colonic diverticula. Am J Surg 171:432–434
Franklin ME Jr, Portillo G, Treviño JM, Gonzalez JJ, Glass JL (2008) Long-term experience with the laparoscopic approach to perforated diverticulitis plus generalized peritonitis. World J Surg 32:1507–1511. doi:10.1007/s00268-007-9463-y
Myers E, Hurley M, O’Sullivan GC, Kavanagh D, Wilson I, Winter DC (2008) Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 95:97–101
Alamili M, Gögenur I, Rosenberg J (2009) Acute complicated diverticulitis managed by laparoscopic lavage. Dis Colon Rectum 52:1345–1349. doi:10.1007/DCR.0b013e3181a0da34
Afshar S, Kurer MA (2012) Laparoscopic peritoneal lavage for perforated sigmoid diverticulitis. Colorectal Dis 14:135–142. doi:10.1111/j.1463-1318.2011.02606.x
Karoui M, Champault A, Pautrat K, Valleur P, Cherqui D, Champault G (2009) Laparoscopic peritoneal lavage or primary anastomosis with defunctioning stoma for Hinchey 3 complicated diverticulitis: results of a comparative study. Dis Colon Rectum 52:609–615. doi:10.1007/DCR.0b013e3181a0a674
Rogers AC, Collins D, O’Sullivan GC, Winter DC (2012) Laparoscopic lavage for perforated diverticulitis: a population analysis. Dis Colon Rectum 55:932–938. doi:10.1097/DCR.0b013e31826178d0
Liang S, Russek K, Franklin ME Jr (2012) Damage control strategy for the management of perforated diverticulitis with generalized peritonitis: laparoscopic lavage and drainage vs. laparoscopic Hartmann’s procedure. Surg Endosc 26:2835–2842
Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EA (2006) Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20:14–29
Andersen JC, Bundgaard L, Elbrønd H, Laurberg S, Walker LR, Støvring J (2012) Danish Surgical Society. Danish national guidelines for treatment of diverticular disease. Dan Med J 59:C4453
Øresland T, Schultz JK, Yaqub S, Rashidi M, Nilsen FR Scandinavian diverticulitis trial—SCANDIV. A randomized prospective multicentrer trial. http://www.scandiv.com/Scandiv/SCANDIV_files/Scandivprotokoll110110.pdf
Thornell A, Angenete E, Gonzales E, Heath J, Jess P, Läckberg Z, Ovesen H, Rosenberg J, Skullman S, Haglind E (2011) Scandinavian Surgical Outcomes Research Group, SSORG. Treatment of acute diverticulitis laparoscopic lavage vs. resection (DILALA): study protocol for a randomised controlled trial. Trial 12:186. doi:10.1186/1745-6215-12-186
ClinicalTrials.gov. LapLAND laparoscopic lavage for acute non-faeculant diverticulitis. http://www.clinicaltrials.gov/show/NCT01019239
Swank HA, Vermeulen J, Lange JF, Mulder IM, van der Hoeven JA, Stassen LP, Crolla RM, Sosef MN, Nienhuijs SW, Bosker RJ, Boom MJ, Kruyt PM, Swank DJ, Steup WH, de Graaf EJ, Weidema WF, Pierik RE, Prins HA, Stockmann HB, Tollenaar RA, van Wagensveld BA, Coene PP, Slooter GD, Consten EC, van Duijn EB, Gerhards MF, Hoofwijk AG, Karsten TM, Neijenhuis PA, Blanken-Peeters CF, Cense HA, Mannaerts GH, Bruin SC, Eijsbouts QA, Wiezer MJ, Hazebroek EJ, van Geloven AA, Maring JK, D’Hoore AJ, Kartheuser A, Remue C, van Grevenstein HM, Konsten JL, van der Peet DL, Govaert MJ, Engel AF, Reitsma JB, Bemelman WA (2010) Dutch Diverticular Disease (3D) Collaborative Study Group. The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitis and Hartmann’s procedure or resection with primary anastomosis for purulent or faecal peritonitis in perforated diverticulitis (NTR2037). BMC Surg 10:29. doi:10.1186/1471-2482-10-29
Swank HA, Mulder IM, Hoofwijk AG, Nienhuijs SW, Lange JF, Bemelman WA (2013) Dutch Diverticular Disease Collaborative Study Group. Early experience with laparoscopic lavage for perforated diverticulitis. Br J Surg 100:704–710. doi:10.1002/bjs.9063
Scheidbach H, Schneider C, Rose J, Konradt J, Gross E, Bärlehner E, Pross M, Schmidt U, Köckerling F, Lippert H (2004) Laparoscopic approach to treatment of sigmoid diverticulitis: changes in the spectrum of indications and results of a prospective, multicenter study on 1545 patients. Dis Colon Rectum 47:1883–1888
Siddiqui MR, Sajid MS, Baig MK (2010) Open vs. laparoscopic approach for reversal of Hartmann’s procedure: a systematic review. Colorectal Dis 12:733–741. doi:10.1111/j.1463-1318.2009.01892.x
Menenakos E, Hahnloser D, Nassiopoulos K, Chanson C, Sinclair V, Petropoulos P (2003) Laparoscopic surgery for fistulas that complicate diverticular disease. Langenbeck Arch Surg 388:189–193
Laurent SR, Detroz B, Detry O, Degauque C, Honoré P, Meurisse M (2005) Laparoscopic sigmoidectomy for fistulized diverticulitis. Dis Colon Rectum 48:148–152
Engledow AH, Pakzad F, Ward NJ, Arulampalam T, Motson RW (2007) Laparoscopic resection of diverticular fistulae: a 10-year experience. Colorectal Dis 9:632–634
Nguyen SQ, Divino CM, Vine A, Reiner M, Katz LB, Salky B (2006) Laparoscopic surgery for diverticular disease complicated by fistulae. JSLS 10:166–168
Bartus CM, Lipof T, Sarwar CM, Vignati PV, Johnson KH, Sardella WV, Cohen JL (2005) Colovesical fistula: not a contraindication to elective laparoscopic colectomy. Dis Colon Rectum 48:233–236
Poulin EC, Schlachta CM, Mamazza J, Seshadri PA (2000) Should enteric fistulas from Crohn’s disease or diverticulitis be treated laparoscopically or by open surgery? A matched cohort study. Dis Colon Rectum 43:621–626
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interests
The authors declare no conflict of interests.
Ethical standard
The study protocol was approved by the Ethics Committee of the Department and conformed to the ethical guidelines of the Helsinki Declaration (as revised in Tokyo 2004).
Research involving human participants and/or animals
No animals but only human participants were engaged in our review.
Informed consent
Since this study is a systemic review, no informed written consent was needed. Patients anonymity was maintained. The study was not advertised and no remuneration was offered.
Rights and permissions
About this article
Cite this article
Bissolati, M., Orsenigo, E. & Staudacher, C. Role of minimally invasive surgery in the treatment of diverticular disease: an evidence-based analysis. Updates Surg 67, 353–365 (2015). https://doi.org/10.1007/s13304-015-0329-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-015-0329-9