Skip to main content

Advertisement

SpringerLink
Log in

Early vs. Delayed Elective Laparoscopic-Assisted Colectomy in Sigmoid Diverticulitis: Timing of Surgery in Relation to the Acute Attack

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

The timing of elective surgery in acute sigmoid diverticulitis in relation to the acute attack is not clear. Early elective surgery during the same hospitalization as the acute attack or delayed surgery after an interval of several weeks are the options. This study was designed to evaluate the influence of timing on morbidity, conversion rate, histologic findings, and costs.

Methods

A total of 178 patients with elective laparoscopic-assisted sigmoid resections for diverticulitis between 1997 and 2005 were retrospectively assessed; 77 patients underwent early and 101 delayed surgery. Outcomes were surgical morbidity, conversion rate, histologic findings, and financial impact of timing.

Results

The two groups showed no significant difference apart from a higher body mass index in the delayed group (25.5 vs. 26.6 kg/m2, P--.035). Surgical morbidity was not significantly different. Conversion rate was significantly higher in the early group (P-lt;-.001). Converted patients had an increased surgical morbidity of 23.8 vs. 19.1 percent (P--.323) and hospitalization was significantly longer (13.5 vs. 10.5 days; P-lt;-.001). Histology revealed inflammation in 75.3 percent in the early group compared with 23.8 percent in the delayed group. Total treatment costs were not different between groups, whereas total earnings were higher in the delayed group resulting in a lower hospital deficit.

Conclusions

Early elective surgery in patients with acute sigmoid diverticulitis results in a higher conversion rate. If patients respond to initial antibiotic therapy, delayed colectomy after an interval of six weeks or more is recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Natarajan S, Ewings EM, Vega RJ. Laparoscopic sigmoid colectomy after acute diverticulitis: when to operate. Surgery 2004;136:725-0.

    Article  PubMed  Google Scholar 

  2. Reissfelder C, Buhr HJ, Ritz JP. What is the optimal time of surgical intervention after an acute attack of sigmoid diverticulitis: early or late elective laparoscopic resection? Dis Colon Rectum 2006;49:1842-

    Article  PubMed  Google Scholar 

  3. Salem L, Veenstra DL, Sullivan SD, Flum DR. The timing of elective colectomy in diverticulitis: a decision analysis. J Am Coll Surg 2004;199:904-2.

    Article  PubMed  Google Scholar 

  4. Halphen M, Blain A. Natural history of colonic diverticulosis. Rev Prat 1995;45:952-.

    CAS  PubMed  Google Scholar 

  5. Rafferty J, Shellito P, Hyman NH, Buie DW. Standards Committee of the American Society of Colon and Rectal Surgeons. Practice Parameters for Sigmoid Diverticulitis. Dis Colon Rectum 2006;49:939-4.

    Article  PubMed  Google Scholar 

  6. Janes S, Meagher A, Frizelle FA. Elective surgery after acute diverticulitis. Br J Surg 2005;92:133-2.

    Article  CAS  PubMed  Google Scholar 

  7. Broderick-Villa G, Burchette RJ, Collins CJ, Abbas MA, Haigh PI. Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Arch Surg 2005;140:576-3.

    Article  PubMed  Google Scholar 

  8. Richards RJ, Hammitt JK. Timing of prophylactic surgery in prevention of diverticulitis recurrence. A cost-effectiveness analysis. Dig Dis Sci 2002;47:1903-.

    Article  PubMed  Google Scholar 

  9. Chapman J, Davies M, Wolff B, et al. Complicated diverticulitis. It is time to rethink the rules? Ann Surg 2005;242:576-3.

    PubMed  Google Scholar 

  10. Salem TA, Molloy RG, O’Dwyer PJ. Prospective study on the management of patients with complicated diverticular disease. Colorectal Dis 2006;8:173-.

    Article  CAS  PubMed  Google Scholar 

  11. Spivak H, Weinrauch S, Harvey JC, Surik B, Ferstenberg H, Friedman I. Acute colonic diverticulitis in the young. Dis Colon Rectum 1997;40:570-.

    Article  CAS  PubMed  Google Scholar 

  12. Sher ME, Agachan F, Bortul M, Nogueras JJ, Weiss EG, Wexner SD. Laparoscopic surgery for diverticulitis. Surg Endosc 1997;11:264-.

    Article  CAS  PubMed  Google Scholar 

  13. Pandya S, Murray JJ, Coller JA, Rusin LC. Laparoscopic colectomy. Indications for conversion to laparotomy. Arch Surg 1999;134:471-.

    Article  CAS  PubMed  Google Scholar 

  14. Slim K, Pezet D, Riff Y, Clark E, Chipponi J. High morbidity rate after converted laparoscopic colorectal surgery. Br J Surg 1995;82:1406-.

    Article  CAS  PubMed  Google Scholar 

  15. Casillas S, Delaney CP, Senagore AJ, Brady K, Fazio VW. Does conversion of a laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum 2004;47:1680-

    Article  PubMed  Google Scholar 

  16. Hoffman GC, Baker JW, Fitchett CW, Vansant JH. Laparoscopic-assisted colectomy. Initial experience. Ann Surg 1994;219:732-3.

    Article  CAS  PubMed  Google Scholar 

  17. Salem L, Flum DR. Primary anastomosis or Hartmann’s procedure for patients with diverticular peritonitis? A systematic review. Dis Colon Rectum 2004;47:1953-4.

    Article  PubMed  Google Scholar 

  18. Vargas HD, Ramirez RT, Hoffman GC, et al. Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis. Dis Colon Rectum 2000;43:1726-1.

    Article  CAS  PubMed  Google Scholar 

  19. Senagore AJ, Duepree HJ, Delany CP, Brady KM, Fazio VW. Results of a standardized technique and postoperative care plan for laparoscopic sigmoid resection. A 30-month experience. Dis Colon Rectum 2003;46:503-

    Article  PubMed  Google Scholar 

  20. Bruce CJ, Coller JA, Murray JJ, Schoetz DJ, Roberts PL, Rusin LC. Laparoscopic resection for diverticular disease. Dis Colon Rectum 1996;39:S1-.

    Article  CAS  PubMed  Google Scholar 

  21. Rose J, Schneider C, Yildirim C, Geers P, Scheidbach H, Köckerling F. Complications in laparoscopic colorectal surgery: results of a multicentre trial. Tech Colonproctol 2004;8:S25-.

    Article  Google Scholar 

  22. Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW. Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 2003;238:67–72.

    Article  PubMed  Google Scholar 

  23. Schmidt CM, Talamini MA, Kaufman HS, Lillimoe KD, Learn P, Bayless T. Laparoscopic surgery for Crohn’s disease: reasons for conversion. Ann Surg 2001;233:733–9.

    Article  CAS  PubMed  Google Scholar 

  24. Gervaz P, Pikarsky A, Utech M, et al. Converted laparoscopic colorectal Surgery: a meta-analysis. Surg Endosc 2001;15:827-2.

    Article  CAS  PubMed  Google Scholar 

  25. Belizon A, Sardinha CT, Sher ME. Converted laparoscopic colectomy. What are the consequences? Surg Endosc 2006;20:947-1

    Article  CAS  PubMed  Google Scholar 

  26. Marusch F, Gastinger I, Schneider C, et al. Importance of conversion for results obtained with laparoscopic colorectal surgery. Dis Colon Rectum 2001;44:207-6.

    Article  CAS  PubMed  Google Scholar 

  27. Le Moine MC, Fabre JM, Vacher C, Navarro F, Picot MC, Domergue J. Factors and consequences of conversion in laparoscopic sigmoidectomy for diverticular disease. Br J Surg 2003;90:232-.

    Article  PubMed  Google Scholar 

  28. Schwandner O, Schiedeck TH, Bruch HP. The role of conversion in laparoscopic colorectal surgery. Do predictive factors exist? Surg Endosc 1999;13:151-

    Article  CAS  PubMed  Google Scholar 

  29. Piardi T, Ferrari Bravo A, Giampaoli F, et al. Deferred elective colonic resection in complicated diverticulitis. Chir Ital 2003;55:153-0.

    PubMed  Google Scholar 

Download references

Acknowledgment

The authors thank Dr. Karen Delport for assistance.

Author information

Authors and Affiliations

  1. Department of Surgery, Triemli Hospital, Zurich, Switzerland

    Urs Zingg M.D., Itai Pasternak M.D., Lukas Guertler M.A., Michael Dietrich M.D. & Urs Metzger M.D., F.R.C.S.

  2. Administration and Finance, Triemli Hospital, Zurich, Switzerland

    Karl-Anton Wohlwend M.A.

Authors
  1. Urs Zingg M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Itai Pasternak M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lukas Guertler M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Dietrich M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karl-Anton Wohlwend M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Urs Metzger M.D., F.R.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Urs Zingg M.D..

About this article

Cite this article

Zingg, U., Pasternak, I., Guertler, L. et al. Early vs. Delayed Elective Laparoscopic-Assisted Colectomy in Sigmoid Diverticulitis: Timing of Surgery in Relation to the Acute Attack. Dis Colon Rectum 50, 1911–1917 (2007). https://doi.org/10.1007/s10350-007-9042-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-007-9042-1

Key words

Search

Navigation