Abstract
Background
Complicated right colonic diverticulitis is more common in Eastern countries. Although this disease entity is treated primarily with surgery, it is uncertain whether the outcomes of laparoscopic treatment also are comparable with those of open surgery. This study aimed to evaluate the outcome for laparoscopic surgical management of complicated right-sided colonic diverticulitis compared with that for open surgery.
Methods
Between 1999 and 2011, 59 patients who underwent extensive surgery for complicated right colonic diverticulitis were enrolled from two hospitals. All the patients were suspected of having a large abscess or perforation with peritonitis symptoms preoperatively. Laparoscopic surgery was performed for 28 consecutive patients in the one hospital, and open surgery was performed for 31 consecutive patients in the other hospital. There was no conversion in the laparoscopic surgery cases. Clinical outcomes were analyzed and compared between the two groups.
Results
Laparoscopic surgery had a longer operating time (165 min) than open surgery (132 min) (p = 0.003). The two groups did not differ significantly in terms of postoperative hospital stay (laparoscopy 9.8 ± 2.7 days versus open surgery 12.8 ± 8.8 days; p = 0.234) or resumption of diet (laparoscopy 5.5 ± 2.4 days versus open surgery 6.3 ± 3.0 days; p = 0.286). Five patients in the laparoscopy group (17.8 %) had complications such as ileus, abscess, and bleeding, one of whom was treated with surgery. Nine patients in the open surgery group (29 %) had complications, two of whom were treated with surgery.
Conclusions
The laparoscopic approach to complicated right colonic diverticulitis may be feasible. The clinical outcomes were comparable with those for open surgery.
Similar content being viewed by others
References
Yang HR, Huang HH, Wang YC, Hsieh CH, Chung PK, Jeng LB, Chen RJ (2006) Management of right colon diverticulitis: a 10-year experience. World J Surg 30:1929–1934
Oudenhoven LF, Koumans RK, Puylaert JB (1998) Right colonic diverticulitis: US and CT findings: new insights about frequency and natural history. Radiology 208:611–618
Komuta K, Yamanaka S, Okada K, Kamohara Y, Ueda T, Makimoto N, Shiogama T, Furui J, Kanematsu T (2004) Toward therapeutic guidelines for patients with acute right colonic diverticulitis. Am J Surg 187:233–237
The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short-term benefits for laparoscopic colorectal resection (review). Cochrane Database Syst Rev 20:3. Article no. CD003145
Afshar S, Kurer MA (2011) Laparoscopic peritoneal lavage for perforated sigmoid diverticulitis. Colorectal Dis. doi:10.1111/j.1463-1318.2011.02606.x
Sher ME, Agachan F, Bortul M, Nogueras JJ, Weiss EG, Wexner SD (1997) Laparoscopic surgery for diverticulitis. Surg Endosc 11:264–267
Tong DK, Law WL (2007) Laparoscopic versus open right hemicolectomy for carcinoma of the colon. JSLS 11:76–80
Li JC, Lee JF, Ng SS, Yiu RY, Hon SS, Leung WW, Leung KL (2010) Conversion in laparoscopic-assisted colectomy for right colon cancer: risk factors and clinical outcomes. Int J Colorectal Dis 25:983–988
Li JC, Ng SS, Lee JF, Yiu RY, Hon SS, Leung WW, Leung KL (2009) Emergency laparoscopic-assisted versus open right hemicolectomy for complicated cecal diverticulitis: a comparative study. J Laparoendosc Adv Surg Tech A 19:479–483
Ng SS, Lee JF, Yiu RY, Li JC, Leung WW, Leung KL (2008) Emergency laparoscopic-assisted versus open right hemicolectomy for obstructing right sided colonic carcinoma: a comparative study of short-term clinical outcomes. World J Surg 32:454–458
Zheng MH, Feng B, Lu AG, Li JW, Wang ML, Mao ZH, Hu YY, Dong F, Hu WG, Li DH, Zang L, Peng YF, Yu BM (2005) Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma. World J Gastroenterol 1:323–326
Gonzalez R, Smith CD, Mattar SG, Venkatesh KR, Mason E, Duncan T, Wilson R, Miller J, Ramshaw BJ (2004) Laparoscopic vs open resection for the treatment of diverticular disease. Surg Endosc 18:276–280
Falk PM, Beart RW Jr, Wexner SD, Thorson AG, Jagelman DG, Lavery IC, Johansen OB, Fitzgibbons RJ Jr (1993) Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 36:28–34
Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359:2224–2229
Hazebroek EJ, Color Study Group (2002) COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc 16:949–953
Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G, Clinical Outcomes of Surgical Therapy (COST) Study Group (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328
Fielding GA, Lumley J, Nathanson L, Hewitt P, Rhodes M, Stitz R (1997) Laparoscopic colectomy. Surg Endosc 11:745–749
Berthou JC, Charbonneau P (1999) Elective laparoscopic management of sigmoid diverticulitis: results in a series of 110 patients. Surg Endosc 13:457–460
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 16:1320–1323
Stevenson AR, Stitz RW, Lumley JW, Fielding GA (1998) Laparoscopically assisted anterior resection for diverticular disease: follow-up of 100 consecutive patients. Ann Surg 227:335–342
Disclosures
Jae Woo Kwon, Byung Seup Kim, Hyoung-Chul Park, Heung-Kwon Oh, Rumi Shin, Seung-Bum Ryoo, Kyu Joo Park, and Bong Hwa Lee have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kwon, J.W., Kim, B.S., Park, HC. et al. Surgical treatment of complicated right colonic diverticulitis: laparoscopic versus open surgery. Surg Endosc 26, 2926–2930 (2012). https://doi.org/10.1007/s00464-012-2286-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-012-2286-4