Hand-assisted laparoscopic sigmoidectomy for diverticulitis

Abstract

BACKGROUND: Sigmoid colectomy for diverticular disease, a routine procedure when performed using standard open methods, can prove much more challenging using minimum access techniques. Hand-assisted laparoscopic colectomy is a new technique that reportedly has a minimum learning curve, yet retains the benefits of a laparoscopic procedure. The purpose of this study was to perform and then prospectively to evaluate the outcome of this procedure on patients needing elective sigmoidectomy for diverticular disease. METHODS: Hand-assisted laparoscopic sigmoidectomy was performed on all patients undergoing elective sigmoidectomy for diverticular disease between January 18, 1996, and November 21, 1996. RESULTS: The study group consisted of six men and three women. Age averaged 50.8 (range, 39–66) years, weight averaged 183 (range, 150–224) pounds, and operation time averaged 3 hours and 42 minutes (range, 3–5 hours). No cases were converted to open methods. There were two minor postoperative complications (bleeding from the staple line, 1 patient; urinary retention, 1 patient; 22 percent). Resumption of flatus (which was the indication to start the patient on an oral diet) occurred between one and three (average, 1.44) days postoperatively. Patients were discharged from the hospital between one and three (average, 2.1) days postoperatively. Primary surgeon responsibility was distributed among four different surgeons, of which only the lead author previously had performed laparoscopic colectomy at this institution. CONCLUSIONS: Hand-assisted laparoscopic sigmoidectomy is a procedure that has a minimum learning curve, yet retains the benefits of a laparoscopic procedure.