Surgical Endoscopy

, Volume 27, Issue 5, pp 1766–1771 | Cite as

Laparoscopic sigmoidectomy in moderate and severe diverticulitis: analysis of short-term outcomes in a continuous series of 121 patients

  • Luigi De Magistris
  • Juan Santiago Azagra
  • Martine Goergen
  • Vito De Blasi
  • Luca Arru
  • Olivier Facy
Article

Abstract

Background

The role of laparoscopic surgery has been shown to be safe, feasible, and equivalent to open surgery for moderate diverticulitis, but its role in severe disease is still being elucidated. The aim of this study was to compare short-term outcomes in patients who underwent laparoscopic sigmoidectomy for moderate and severe diverticulitis.

Methods

All patients who had elective laparoscopic sigmoidectomy for diverticulitis between April 2003 and September 2011 at the University Hospital of Luxembourg were selected from a retrospective database. The patients were divided in two groups: moderate acute diverticulitis (MAD) included patients with an episode of left-lower-quadrant pain, elevated inflammatory markers, and radiologic evidence of diverticulitis, and severe acute diverticulitis (SAD) included patients with diverticula associated with abscess, phlegmon, perforation, fistula, obstruction, bleeding, or stricture.

Results

A total of 121 patients (81 MAD and 40 SAD) underwent elective laparoscopic sigmoidectomy with primary anastomosis. There were no significant differences between the two groups with respect to demographic characteristics, except for sex ratio. In this series the overall morbidity rate at 30 postoperative days (POD) was 12.4 %, with no significant differences between MAD and SAD (16.0 vs. 5 %, respectively; P = 0.083). No significant differences were found with respect to mean length of hospital stay (6.7 vs. 7.7 days; P = 0.399) as well. The overall conversion rate to open surgery was 2.5 % (3 patients), with no difference between the two groups. Conversion to laparotomy was associated with an increased morbidity rate (11.0 % for full laparoscopy vs. 66.6 % for conversion; P = 0.040) and a longer length of stay (6.8 vs. 16.7 days; P = 0.008). There were no deaths within 30 POD.

Conclusions

Elective laparoscopic sigmoidectomy is safe and feasible for patients with moderate and severe acute diverticulitis and the outcomes are equivalent.

Keywords

Laparoscopy Laparoscopic sigmoidectomy Colorectal surgery Complicated diverticulitis Acute diverticulitis 

Notes

Acknowledgments

The authors thank Dr. Andrea Borlizzi for the implementation of statistical analysis and Dr. Deborah McIntyre and Dr. Marc Felten for editing the English language of the manuscript.

Disclosures

Drs. Luigi De Magistris, Juan Santiago Azagra, Martine Goergen, Vito De Blasi, Luca Arru, and Olivier Facy have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    American Gastrointestinal Association (2001) The burden of gastrointestinal diseases. American Gastroenterological Association, BethesdaGoogle Scholar
  2. 2.
    Hjern F, Josephon T, Altman D, Holmström B, Johansson C (2008) Outcome of younger patients with acute diverticulitis. Br J Surg 95:758–764PubMedCrossRefGoogle Scholar
  3. 3.
    Ferzoco LB, Raptopoulos V, Silen W (1998) Acute diverticulitis. N Engl J Med 338(21):1521–1526PubMedCrossRefGoogle Scholar
  4. 4.
    Peppas G, Bliziotis IA, Oikonomaki D, Falagas ME (2007) Outcomes after medical and surgical treatment of diverticulitis: a systematic review of the available evidence. J Gastroenterol Hepatol 22(9):1360–1368PubMedCrossRefGoogle Scholar
  5. 5.
    Rafferty J, Shellito P, Hyman NH, Buie WD, Standards Committee of American Society of Colon and Rectal Surgeons (2006) Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 49:939–944PubMedCrossRefGoogle Scholar
  6. 6.
    Klarenbeek BR, Veenhof AA, de Lange ES, Bemelman WA, Bergamaschi R, Heres P, Lacy AM, van den Broek WT, van der Peet DL, Cuesta MA (2007) The Sigma-trial protocol: a prospective double-blind multi-centre comparison of laparoscopic versus open elective sigmoid resection in patients with symptomatic diverticulitis. BMC Surg 7:16PubMedCrossRefGoogle Scholar
  7. 7.
    Ballantyne GH (1995) Laparoscopic-assisted colorectal surgery: review of results in 752 patients. Gastroenterologist 3(1):75–89PubMedGoogle Scholar
  8. 8.
    Huscher C, Silecchia G, Croce E, Farello GA, Lezoche E, Morino M, Azzola M, Feliciotti F, Rosato P, Tarantini M, Basso N (1996) Laparoscopic colorectal resection: a multicenter Italian study. Surg Endosc 10(9):875–879PubMedCrossRefGoogle Scholar
  9. 9.
    Liberman MA, Phillips EH, Carroll BJ, Fallas M, Rosenthal R (1996) Laparoscopic colectomy vs traditional colectomy for diverticulitis. Outcome and costs. Surg Endosc 10(1):15–18PubMedCrossRefGoogle Scholar
  10. 10.
    Ramos JM, Beart RW Jr, Goes R, Ortega AE, Schlinkert RT (1995) Role of laparoscopy in colorectal surgery. A prospective evaluation of 200 cases. Dis Colon Rectum 38(5):494–501PubMedCrossRefGoogle Scholar
  11. 11.
    Wong WD, Wexner SD, Lowry A, Vernava A 3rd, Burnstein M, Denstman F, Fazio V, Kerner B, Moore R, Olivier G, Peters W, Ross T, Senatore P, Simmang C (2000) Practice parameters for the treatment of sigmoid diverticulitis—supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 43:290–297PubMedCrossRefGoogle Scholar
  12. 12.
    Ambrosetti P, Jenny A, Becker C, Terrier TF, Morel P (2000) Acute left colonic diverticulosis—compared performance of computed tomography and water-soluble contrast enema: prospective evaluation of 420 patients. Dis Colon Rectum 43(10):1363–1367PubMedCrossRefGoogle Scholar
  13. 13.
    Garrett KA, Champagne BJ, Valerian BT, Peterson D, Lee EC (2008) A single training center’s experience with 200 consecutive cases of diverticulitis: can all patients be approached laparoscopically? Surg Endosc 22:2503–2508PubMedCrossRefGoogle Scholar
  14. 14.
    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(1):39–44PubMedCrossRefGoogle Scholar
  15. 15.
    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(3):431–435PubMedCrossRefGoogle Scholar
  16. 16.
    Hassan I, Cima RR, Larson WD, 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(10):1690–1694PubMedCrossRefGoogle Scholar
  17. 17.
    Gervaz P, Pikarsky A, Utech M, Secic M, Efron J, Belin B, Jain A, Wexner S (2001) Converted laparoscopic colorectal surgery. Surg Endosc 15(8):827–832PubMedCrossRefGoogle Scholar
  18. 18.
    Slim K, Pezet D, Riff Y, Clark E, Chipponi J (1995) High morbidity rate after converted laparoscopic colorectal surgery. Br J Surg 82(10):1406–1408PubMedCrossRefGoogle Scholar
  19. 19.
    Levak M, Berger D, Sylla P, Rattner D, Bordeianou L (2011) Laparoscopy decreases anastomotic leak rate in sigmoid colectomy for diverticulitis. Arch Surg 146(2):207–210CrossRefGoogle Scholar
  20. 20.
    Martel G, Bouchard A, Soto MC, Poulin EC, Mamazza J, Boushey RP (2010) Laparoscopic colectomy for complex diverticular disease: a justifiable choice? Surg Endosc 24(9):2273–2280PubMedCrossRefGoogle Scholar
  21. 21.
    Schlachta CM, Mamazza J, Poulin EC (1999) Laparoscopic sigmoid resection for acute and chronic diverticulitis. An outcomes comparison with laparoscopic resection for nondiverticular disease. Surg Endosc 13(7):649–653PubMedCrossRefGoogle Scholar
  22. 22.
    Frileux P, Dubrez J, Burdy G, Roullet-Audy JC, Dalban-Sillas B, Bonnaventure F, Frileux M-A (2010) Sigmoid diverticulitis. Longitudinal analysis of 222 patients with a minimal follow up of 5 years. Colorectal Dis 12(7):674–680PubMedCrossRefGoogle Scholar
  23. 23.
    Royds J, O’Riordan J, Eguare E, O’Riordain D, Neary P (2012) Laparoscopic surgery for complicated diverticular disease: a single centre experience. Colorectal Dis 14(10):1248–1254PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Luigi De Magistris
    • 1
    • 2
  • Juan Santiago Azagra
    • 1
  • Martine Goergen
    • 1
  • Vito De Blasi
    • 1
  • Luca Arru
    • 1
  • Olivier Facy
    • 1
  1. 1.Department of General and Mini-Invasive SurgeryCentre Hospitalier de LuxembourgLuxembourgLuxembourg
  2. 2.LuxembourgLuxembourg

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