Acute laparoscopic intervention for diverticular disease (AIDD): a feasible approach

  • Marty Zdichavsky
  • Frank A. Granderath
  • Gunnar Blumenstock
  • Michael Kramer
  • Markus A. Küper
  • Alfred Königsrainer
Original Article



Early laparoscopic rectosigmoid resection for acute complicated diverticulitis may avoid secondary hospital stay and stoma-related complications. Benefits of elective surgical therapies could advance the early laparoscopic approach for acute sigmoid diverticulitis.

Material and methods

From January 2006 to April 2007, a total of 26 patients underwent laparoscopic rectosigmoid resection for acute complicated diverticulitis. Laparoscopy was performed after initial antibiotic treatment and within 10 days after admission to the hospital. Characteristics and outcome were recorded prospectively.


Mean age for 13 females was 63.3 years (range, 45–78 years) and for 13 males was 56.2 years (range, 37–76 years). A body mass index of ≥25.0 kg/m2 was registered in 20/26 patients. Mean operative time was 122.1 min (range, 60–192 min) and mean length of the sigmoid specimen was 179 mm (range, 120–240 mm). Mean time of recovery after surgery was 7.9 days (range, 6–12 days). Operative-related complications were two wound seromas. No anastomotic leak was observed. One month postoperatively, a condition-specific quality of life questionnaire assessed significant increase of the general score index, emotional status, and medical treatment.


This prospective study demonstrates the feasibility of an early laparoscopic rectosigmoid resection for acute complicated diverticulitis with an excellent outcome and a low morbidity rate.


Laparoscopic rectosigmoidectomy Diverticulitis Acute Complicated 


  1. 1.
    Ferzoco LB, Raptopoulos V, Silen W (1998) Acute diverticulitis. N Engl J Med 338:1521–1526CrossRefPubMedGoogle Scholar
  2. 2.
    Stollman N, Raskin JB (2004) Diverticular disease of the colon. Lancet 363:631–639CrossRefPubMedGoogle Scholar
  3. 3.
    Parks TG (1975) Natural history of diverticular disease of the colon. Clin Gastroenterol 4:53–69PubMedGoogle Scholar
  4. 4.
    Khosraviani K, Campbell WJ, Parks TG, Irwin ST (2000) Hartmann procedure revisited. Eur J Surg 166:878–881CrossRefPubMedGoogle Scholar
  5. 5.
    Belmonte C, Klas JV, Perez JJ, Wong WD, Rothenberger DA, Goldberg SM, Madoff RD (1996) The Hartmann procedure. First choice or last resort in diverticular disease? Arch Surg 131:612–615, discussion 616–617PubMedGoogle Scholar
  6. 6.
    Hinchey EJ, Schaal PG, Richards GK (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109PubMedGoogle Scholar
  7. 7.
    Hansen O, Stock W (1999) Prophylaktische Operation bei der Divertikelkrankheit des Kolons: Stufenkonzept durch exakte Stadieneinteilung. Langenbecks Arch Chir (Suppl II):1257Google Scholar
  8. 8.
    Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, Troidl H (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222CrossRefPubMedGoogle Scholar
  9. 9.
    Bouillot JL, Aouad K, Badawy A, Alamowitch B, Alexandre JH (1998) Elective laparoscopic-assisted colectomy for diverticular disease. A prospective study in 50 patients. Surg Endosc 12:1393–1396CrossRefPubMedGoogle Scholar
  10. 10.
    Bouillot JL, Berthou JC, Champault G, Meyer C, Arnaud JP, Samama G, Collet D, Bressler P, Gainant A, Delaitre B (2002) Elective laparoscopic colonic resection for diverticular disease: results of a multicenter study in 179 patients. Surg Endosc 16:1320–1323CrossRefPubMedGoogle Scholar
  11. 11.
    Franklin ME Jr, Dorman JP, Jacobs M, Plasencia G (1997) Is laparoscopic surgery applicable to complicated colonic diverticular disease? Surg Endosc 11:1021–1025CrossRefPubMedGoogle Scholar
  12. 12.
    Sher ME, Agachan F, Bortul M, Nogueras JJ, Weiss EG, Wexner SD (1997) Laparoscopic surgery for diverticulitis. Surg Endosc 11:264–267CrossRefPubMedGoogle Scholar
  13. 13.
    Smadja C, Sbai Idrissi M, Tahrat M, Vons C, Bobocescu E, Baillet P, Franco D (1999) Elective laparoscopic sigmoid colectomy for diverticulitis. Results of a prospective study. Surg Endosc 13:645–648CrossRefPubMedGoogle Scholar
  14. 14.
    Stevenson AR, Stitz RW, Lumley JW, Fielding GA (1998) Laparoscopically assisted anterior resection for diverticular disease: follow-up of 100 consecutive patients. Ann Surg 227:335–342CrossRefPubMedGoogle Scholar
  15. 15.
    Vargas HD, Ramirez RT, Hoffman GC, Hubbard GW, Gould RJ, Wohlgemuth SD, Ruffin WK, Hatter JE, Kolm P (2000) Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis. Dis Colon Rectum 43:1726–1731CrossRefPubMedGoogle Scholar
  16. 16.
    Makela J, Vuolio S, Kiviniemi H, Laitinen S (1998) Natural history of diverticular disease: when to operate? Dis Colon Rectum 41:1523–1528CrossRefPubMedGoogle Scholar
  17. 17.
    Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C (2002) Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum 45:962–966CrossRefPubMedGoogle Scholar
  18. 18.
    Dobbins C, Defontgalland D, Duthie G, Wattchow DA (2006) The relationship of obesity to the complications of diverticular disease. Colorectal Dis 8:37–40CrossRefPubMedGoogle Scholar
  19. 19.
    Chintapalli KN, Chopra S, Ghiatas AA, Esola CC, Fields SF, Dodd GD 3rd (1999) Diverticulitis versus colon cancer: differentiation with helical CT findings. Radiology 210:429–435PubMedGoogle Scholar
  20. 20.
    Reissfelder C, Buhr HJ, Ritz JP (2006) Can laparoscopically assisted sigmoid resection provide uncomplicated management even in cases of complicated diverticulitis? Surg Endosc 20:1055–1059CrossRefPubMedGoogle Scholar
  21. 21.
    Menenakos E, Hahnloser D, Nassiopoulos K, Chanson C, Sinclair V, Petropoulos P (2003) Laparoscopic surgery for fistulas that complicate diverticular disease. Langenbecks Arch Surg 388:189–193CrossRefPubMedGoogle Scholar
  22. 22.
    Kohler L, Sauerland S, Neugebauer E (1999) Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery. Surg Endosc 13:430–436CrossRefPubMedGoogle Scholar
  23. 23.
    Bergamaschi R, Arnaud JP (1998) Anastomosis level and specimen length in surgery for uncomplicated diverticulitis of the sigmoid. Surg Endosc 12:1149–1151CrossRefPubMedGoogle Scholar
  24. 24.
    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 13:325–327CrossRefPubMedGoogle Scholar
  25. 25.
    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. Langenbecks Arch Surg 389:97–103CrossRefPubMedGoogle Scholar
  26. 26.
    Maartense S, Dunker MS, Slors JF, Cuesta MA, Pierik EG, Gouma DJ, Hommes DW, Sprangers MA, Bemelman WA (2006) Laparoscopic-assisted versus open ileocolic resection for Crohn's disease: a randomized trial. Ann Surg 243:143–149, discussion 150–153CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Marty Zdichavsky
    • 1
  • Frank A. Granderath
    • 2
  • Gunnar Blumenstock
    • 3
  • Michael Kramer
    • 1
  • Markus A. Küper
    • 1
  • Alfred Königsrainer
    • 1
  1. 1.Division of General, Visceral and Transplant SurgeryUniversity Hospital TuebingenTuebingenGermany
  2. 2.Department of SurgeryNeuwerk Hospital Maria von den ApostelnMoenchengladbachGermany
  3. 3.Department of Medical BiometryUniversity Hospital TuebingenTuebingenGermany

Personalised recommendations