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The Impact of Uncomplicated and Complicated Diverticulitis on Laparoscopic Surgery Conversion Rates and Patient Outcomes

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Abstract

Background

The aim of this analysis was to determine the impact of complicated and uncomplicated diverticulitis on conversion rates and complications in patients undergoing laparoscopic surgery (LS) for diverticular disease.

Methods

Between 1993 and 2004, 125 patients underwent LS [91 laparoscopic-assisted (LA) and 34 hand-assisted (HA) colectomy for diverticular disease, 79 uncomplicated and 46 complicated]. Cases not completed laparoscopically were considered converted. Complicated diverticulitis was defined as diverticular disease associated with abscess, fistula, bleeding or stricture.

Results

The mean age was 59 years with 67 (54%) men with a mean follow-up of 23 months. The conversion rate was 26% (33 patients). The only factor independently associated with conversion was a history of previous abdominal surgery (37% vs. 14%, p = 0.004). Among the subset of patients undergoing surgery for uncomplicated diverticulitis, the number of diverticulitis episodes (DE), the time between the first and last DE, and the time between the last DE and surgery, were not significantly associated with conversion. Early complications (<30 days from surgery) occurred in 30 (25%) patients. Twenty-one long-term complications (>30 days from surgery) occurred in 20 patients and the one and two-year cumulative probabilities of these complications were 14% and 22%, respectively. Early complications were significantly higher among patients requiring conversion (44% vs. 24%, p = 0.04) but were not significantly higher among patients with complicated diverticulitis (39% vs. 24%, p = 0.11). The rates of long-term complications were not significantly higher among patients that required conversion or had complicated diverticulitis (one-year rate 23% vs. 11%, p = 0.47; 18% vs. 13%, p = 0.70).

Conclusions

A previous history of abdominal surgery was associated with a higher conversion rate in patients undergoing laparoscopic surgery for diverticular disease. Long-term patient outcomes are not adversely impacted by laparoscopic surgery for complicated diverticulitis or laparoscopic surgery requiring conversion to an open procedure.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA

    Imran Hassan, Robert R. Cima, David W. Larson, Eric J. Dozois & John H. Pemberton

  2. Section of Biostatistics, Mayo Clinic, Rochester, MN, 55905, USA

    Megan M. O’ Byrne & Dirk R. Larson

Authors
  1. Imran Hassan
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  2. Robert R. Cima
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  3. David W. Larson
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  4. Eric J. Dozois
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  5. Megan M. O’ Byrne
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  6. Dirk R. Larson
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  7. John H. Pemberton
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Corresponding author

Correspondence to Robert R. Cima.

Additional information

Presented in parts at the Society of American Gastrointestinal and Endoscopic Surgeons, Dallas, TX, April 2006; the 10th World Congress of Endoscopic Surgery, Berlin, Germany, September 2006; and the Annual meeting of the Association of Coloproctology of Great Britain and Ireland, Newcastle, England, July 2006

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Hassan, I., Cima, R.R., Larson, D.W. et al. The Impact of Uncomplicated and Complicated Diverticulitis on Laparoscopic Surgery Conversion Rates and Patient Outcomes . Surg Endosc 21, 1690–1694 (2007). https://doi.org/10.1007/s00464-007-9413-7

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  • DOI: https://doi.org/10.1007/s00464-007-9413-7

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