PURPOSE: Operating room time and anastomosis-related morbidity of laparoscopic-assisted sigmoid resection with anastomosis performed in an open fashion through a horizontal suprapubic incision or laparoscopically after re-establishing pneumoperitoneum were compared. METHODS: A randomized trial was performed on patients with recurrent uncomplicated diverticulitis of the sigmoid colon during a 14-month period. Inclusion criteria were persistence of symptoms despite medical treatment and two previous admissions. Exclusion criteria included complicated diverticulitis, suspected cancer, and previous extensive abdominal surgery. Because skin incisions were similar and patients were randomly assigned in the operating room, the trial was performed as double blind. RESULTS: There were no deaths. Two patients were excluded before randomization. Three patients were not treated as allocated because of conversion to open surgery. Aside from previous abdominal-surgery rates, 16 patients with laparoscopic-assisted sigmoid resections after re-establishing pneumoperitoneum and 15 patients with laparoscopic-assisted sigmoid resections with anastomosis performed in an open fashion through a horizontal suprapubic incision were well-matched for age, gender, weight, American Society of Anesthesiology class, previous admissions, skin-incision length, size of circular stapler, and mobilization of splenic flexure. There were no significant differences in morbidity rates (3/16vs. 3/15), complete doughnuts (16/16vs. 15/15), blood loss (300vs. 200 ml), flatus (4vs. 4 days), solid-food resumption (5vs. 6 days), stay (8.5vs. 9 days) in laparoscopic-assisted sigmoid resection after re-establishing pneumoperitoneum and laparoscopic-assisted sigmoid resection with anastomosis performed in an open fashion through a horizontal suprapubic incision groups, respectively. Patients with laparoscopic-assisted sigmoid resection after re-establishing pneumoperitoneum had statistically longer operating room time (295vs. 190 minutes;P<0.01). Median follow-up was 12 and 10 months in 10 patients with laparoscopic-assisted sigmoid resection after reestablishing pneumoperitoneum and 11 patients with laparoscopic-assisted sigmoid resection with anastomosis performed in an open fashion through a horizontal suprapubic incision, respectively. One patient with laparoscopic-assisted sigmoid resection with anastomosis performed in an open fashion through a horizontal suprapubic incision had an anastomotic stenosis endoscopically dilated. CONCLUSIONS: Nonrestoration of pneumoperitoneum after laparoscopic-assisted sigmoid resection allows a decrease in operating room time and a similar outcome.
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Paik PS, Beart RW. Laparoscopic colectomy. Surg Clin North Am 1997;77:1–13.
Begos DG, Ballantyne GH. Laparoscopic left hemicolectomy and anterior resection. In: Monson JR, Darzi A, eds. Laparoscopic colorectal surgery. Oxford: Isis Medical Media, 1995:31–2.
Schirmer BD. Laparoscopic colon resection. Surg Clin North Am 1996;76:571–83.
Lezoche E, Paganini AM, Feliciotti F. A new technique to facilitate laparoscopic resection of low rectal tumors. Surg Laparosc Endosc 1997;7:9–12.
Bergamaschi R, Arnaud JP. Immediately recognizable benefits and drawbacks after laparoscopic colon resection for benign disease. Surg Endosc 1997;11:802–4.
Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg 1978;12:85–109.
Troidl H, Spangenberger W, Dietrich A, Neugebauer E. Laparoskopische Cholecystectomie. Erste Erfahrungen und Ergebnisse bei 300 Operationen: eine prospektive Beobachtungsstudie. Chirurg 1991;62:257–65.
Falk PM, Beart RW Jr, Wexner SD,et al. Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 1993;36:28–34.
Reissman P, Cohen S, Weiss EG, Wexner SD. Laparoscopic colorectal surgery: ascending the learning curve. World J Surg 1996;20:277–82.
Wishner JD, Baker JW Jr, Hoffman GC,et al. Laparoscopic-assisted colectomy. The learning curve. Surg Endosc 1995;9:1179–83.
Agachan F, Joo JS, Sher M, Weiss EG, Nogueras JJ, Wexner SD. Laparoscopic colorectal surgery. Do we get faster? Surg Endosc 1997;11:331–5.
Forde KA. Minimal access and open surgery. Competition or integration? Surg Endosc 1997;11:1063–4.
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Bergamaschi, R., Tuech, J.J., Cervi, C. et al. Re-establish pneumoperitoneum in laparoscopic-assisted sigmoid resection?. Dis Colon Rectum 43, 771–774 (2000). https://doi.org/10.1007/BF02238012
- Laparoscopic sigmoid resection