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Is there anything we can modify among factors associated with morbidity following elective laparoscopic sigmoidectomy for diverticulitis?

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Abstract

Background

Laparoscopic sigmoidectomy for diverticulitis is widely accepted, using either endolinear staplers or traditional linear staplers under direct vision through the extraction site to transect the rectum. The aim of this study was to assess modifiable factors affecting perioperative morbidity after elective laparoscopic sigmoidectomy for diverticulitis.

Methods

Potential associations between perioperative morbidity and demographic, disease-related, and treatment-related factors were assessed on all consecutive patients included in a prospectively collected database undergoing elective laparoscopic sigmoidectomy for diverticulitis between 1992 and 2013. Rectal transection with a linear stapler under direct vision through the extraction site was considered compatible with laparoscopic technique.

Results

There were two deaths out of 1059 patients (0.19 %). Conversion rate was 13.1 %, overall morbidity 28 %, and anastomotic leak 3.7 %. Independent factors associated with morbidity in an intent-to-treat analysis were ASA 3 (OR 1.53, p = 0.006), conversion (OR 1.71, p = 0.015), and rectal transection without endolinear stapling (traditional linear stapler: OR 1.75, p = 0.003; surgical knife: OR 2.09, p = 0.002). The same factors along with complicated diverticulitis (OR 1.56, p = 0.013) were independently associated with overall morbidity among laparoscopically completed cases. BMI ≥ 35 (OR 2.3, p = 0.017), complicated diverticulitis (OR 2.37, p = 0.002), and rectal transection with a traditional linear stapler (OR 2.19, p = 0.018) were independently associated with abdomino-pelvic infections, both in an intent-to-treat analysis and among laparoscopically completed cases. The number of endolinear stapler firings was not associated with morbidity.

Conclusions

Most factors associated with morbidity of laparoscopic sigmoidectomy for diverticulitis cannot be easily modified. With the limitation of a retrospective analysis, modifiable factors to minimize morbidity are laparoscopic completion and endolinear stapling.

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Abbreviations

ASA:

American Society of Anesthesiology

BMI:

Body mass index

CT:

Computed tomography

IRA:

Ileorectal anastomosis

AR:

Anterior resection

TAC:

Total abdominal colectomy

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA

    Jorge Silva-Velazco, Luca Stocchi, Meagan Costedio, Emre Gorgun, Hermann Kessler & Feza H. Remzi

Authors
  1. Jorge Silva-Velazco
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  2. Luca Stocchi
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  3. Meagan Costedio
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Correspondence to Luca Stocchi.

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Disclosures

Drs. Jorge Silva-Velazco, Luca Stocchi, Meagan Costedio, Emre Gorgun, Hermann Kessler, and Feza Remzi have no conflicts of interest or financial ties to disclose.

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Silva-Velazco, J., Stocchi, L., Costedio, M. et al. Is there anything we can modify among factors associated with morbidity following elective laparoscopic sigmoidectomy for diverticulitis?. Surg Endosc 30, 3541–3551 (2016). https://doi.org/10.1007/s00464-015-4651-6

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  • DOI: https://doi.org/10.1007/s00464-015-4651-6

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