Abstract
Background
This study was designed to asses the predictive factors of postoperative complications in patients who underwent a laparoscopic elective approach for recurrent diverticulitis and to determine the relationship between the number of acute episodes and surgical morbidity.
Methods
A retrospective analysis was performed on patients with colonic diverticular disease treated by an elective laparoscopic approach between July 2000 and November 2007. The variables studied were age, sex, BMI, ASA, number of previous acute episodes, local severity, abdominal surgery history, comorbidity, and laparoscopic training of the surgeon. Logistic regression analysis was used to establish significant results.
Results
A total of 137 patients were analyzed; 87 (63.5%) were men with a mean age of 56.7 (range, 27–89) years. Intraoperative and postoperative complications occurred in 2.9% (n = 4) and 12.4% (n = 17) of the patients respectively. Conversion rate was 9.4% (n = 13). Local severity (odds ratio (OR), 16.34; 95% confidence interval (CI), 4.1–64.5, p = 0.00007), history of abdominal surgery (OR, 3.02; 95% CI, 0.8–11.5; p = 0.02), and the training of the operating surgeon (OR, 4.8; 95% CI, 1.02–22.7; p = 0.001) were significant risk factors related to surgery conversion. A history of three or more acute episodes was significantly associated with a high severity of local process and was a risk factor related to conversion (OR, 2.6; 95% CI, 0.5–12.3; p = 0.22). The severity of the local process seems to be a risk factor for perioperative complications. A significant association (χ2, 4.45; p = 0.03) between conversion and postoperative complications also was observed (OR: 3.79, 95% CI, 1.02–14.07; p = 0.04).
Conclusions
A history of three or more acute episodes of diverticulitis with conservative treatment is associated with a high severity of the local process during laparoscopic sigmoidectomy and increases the rate of conversion and perioperative complications.
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References
Frattini J, Longo WE (2006) Diagnosis and treatment of chronic and recurrent diverticulitis. J Clin Gastroenterol 40(7 Suppl 3):S145–S149
Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238:67–72
Le Moine MC, Fabre JM, Vacher C, Navarro F, Picot MC, Domergue J (2003) Factors and consequences of conversion in laparoscopic sigmoidectomy for diverticular disease. Br J Surg 90:232–236
Belizon A, Sardinha CT, Sher ME (2006) Converted laparoscopic colectomy: what are the consequences? Surg Endosc 20:947–951
Oomen JL, Engel AF, Cuesta MA (2006) Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient related factors. Colorectal Dis 8:112–119
Oomen JL, Engel AF, Cuesta MA (2006) Outcome of elective primary surgery for diverticular disease of the sigmoid colon: a risk analysis based on the POSSUM scoring system. Colorectal Dis 8:91–97
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 389:97–103
Schiedeck TH, Schwandner O, Bruch HP (1998) Laparoscopic sigmoid resection for diverticulitis. Chirurg 69:846–853
Köckerling F, Schneider C, Reymond MA et al (1999) Laparoscopic resection of sigmoid diverticulitis results of a multicenter study group. Surg Endosc 13:567–571
Burgel JS, Navarro F, Lemoine MC, Michel J, Carabalona JP, Fabre JM, Domergue J (2000) Elective laparoscopic colectomy for sigmoid diverticulitis. Prospective study of 56 cases. Ann Chir 125:231–237
Bouillot JL, Berthou JC, Champault G et al (2002) Elective laparoscopic colonic resection for diverticular disease—results of a multicenter study in 179 patients. Surg Endosc 16:1320–1323
Ambrosetti P, Chautems R, Soravia C et al (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
Ambrosetti P, Grossholz M, Becker C, Terrier F, Morel P (1997) Computed tomography in acute left colonic diverticulitis. Br J Surg 84:532–534
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 45:962–966
Rafferty J, Shellito P, Hyman N et al (2006) Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 49:939–944
Guzzo J, Hyman N (2004) Diverticulitis in young patients: is resection always warranted? Dis Colon Rectum 47:1187–1191
Salem L, Veenstra DL, Sullivan SD, Flum DR (2004) The timing of elective colectomy in diverticulitis: a decision analysis J Am Coll Surg 199:904–912
Kim U, Dreiling D (1974) Problems in the diagnosis of diverticulitis in the young. Am J Gastroenterol 62:109–115
Eusebio E, Isenberg M (1973) Natural history of diverticular disease of the colon in young patients. Am J Surg 125:308–311
Rodkey GV, Welch CE (1984) Changing patients in the surgical treatment of diverticular disease. Ann Surg 200:466–478
Freischlag J, Bennion RS, Thompson JE (1986) Complications of diverticular disease of the colon in young people. Dis Colon Rectum 29:639–643
Nelson RS, Velasco A, Mukesh DN (2006) Management of diverticulitis in younger patients. Dis Colon Rectum 49:1341–1345
Wong W, Wexner SD, Lowry A et al (2000) Practice parameters for the treatment of sigmoid diverticulitis: supporting documentation. The standards task force of the American society of colon and rectal surgeons. Dis Colon Rectum 43:289–297
Köhler L, Sauerland S, Neugebauer E (1999) Diagnosis and treatment of diverticular disease. Surg Endosc 13:430–436
Janes S, Meagher A, Frizelle FA (2005) Elective surgery after acute diverticulitis. Br J Surg 92:133–142
Mueller MH, Glaetzer J, Kasparek MS et al (2005) Long-term outcome of conservative treatment in patients with diverticulitis of the sigmoid colon. Eur J Gastroenterol Hepatol 17:649–654
Chapman J, Davies M, Wolff B et al (2005) Complicated diverticulitis: is it time to rethink the rules? Ann Surg 242:576–583
Salem L, Veenstra DL, Sullivan SD et al (2004) The timing of elective colectomy in diverticulitis: a decision analysis. J Am Coll Surg 199:904–912
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Rotholtz, N.A., Montero, M., Laporte, M. et al. Patients with Less Than Three Episodes of Diverticulitis May Benefit from Elective Laparoscopic Sigmoidectomy. World J Surg 33, 2444–2447 (2009). https://doi.org/10.1007/s00268-009-0162-8
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DOI: https://doi.org/10.1007/s00268-009-0162-8