Skip to main content
SpringerLink
Log in

Laparoscopic sigmoid resections for diverticulitis complicated by abscesses or fistulas

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Treatment of choice in recurrent and complicated diverticulitis is surgical resection of the inflamed bowel. Whereas it is accepted that recurrent diverticulitis (RD) can be handled laparoscopically, this is still not generally recommended for complicated diverticulitis (CD). Therefore, we analysed our results of laparoscopic sigmoidectomies concerning intraoperative course, conversion rate, morbidity and hospital stay in RD and CD.

Materials and methods

Between 09/2002 and 01/2006, laparoscopic sigmoidectomies were offered to all patients suffering from recurrent or complicated diverticulitis (Hinchey I+II). All resections were performed in a four-port technique with the use of Ultracision and intraabdominal stapler anastomosis. Data were prospectively collected and retrospectively analysed in an intention-to-treat view.

Results

Out of 127 laparoscopic colectomies, 58 were performed for diverticulitis (RD 32; CD 26). Eight patients with colovesical and one patient with colovaginal fistula are included. Three patients with abscesses underwent pretreatment by percutaneous drainage. Operative time was longer in CD than in RD (205 ± 41 vs 147 ± 34 min; p < 0.001) and associated with higher blood loss, but conversion rate was low (RD, 2/32 vs CD, 3/26; p = 0.64). There was one intraoperative complication in each group; postoperative major complications occurred in 3.13% (RD) vs 11.5% (CD; p = 0.316). One anastomotic leakage occurred in the RD group. Length of hospital stay was shorter for RD than for CD (7.1 ± 3.4 vs 10.7 ± 6.4 days; p = 0.02).

Conclusions

Laparoscopic resections should not be limited to recurrent diverticular disease but can be safely applied for complicated diverticulitis.

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

Fig. 1

Similar content being viewed by others

References

  1. Ferzoco LB, Raptopoulos V, Silen W (1998) Acute diverticulitis. N Engl J Med 338:1521–1526

    Article  CAS  PubMed  Google Scholar 

  2. Farthmann EH, Ruckauer KD, Haring RU (2000) Evidence-based surgery: diverticulitis—a surgical disease? Langenbecks Arch Surg 385:143–151

    Article  CAS  PubMed  Google Scholar 

  3. Alanis A, Papanicolaou GK, Tadros RR, Fielding LP (1989) Primary resection and anastomosis for treatment of acute diverticulitis. Dis Colon Rectum 32:933–939

    Article  CAS  PubMed  Google Scholar 

  4. Kohler L, Sauerland S, Neugebauer E (1999) Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery. Surg Endosc 13:430–436

    Article  CAS  PubMed  Google Scholar 

  5. Ramos JM, Beart RW Jr, Goes R, Ortega AE, Schlinkert RT (1995) Role of laparoscopy in colorectal surgery. A prospective evaluation of 200 cases. Dis Colon Rectum 38:494–501

    Article  CAS  PubMed  Google Scholar 

  6. Kockerling F, Schneider C, Reymond MA, Scheidbach H, Scheuerlein H, Konradt J, Bruch HP, Zornig C, Kohler L, Barlehner E, Kuthe A, Szinicz G, Richter HA, Hohenberger W (1999) Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group. Surg Endosc 13:567–571

    Article  CAS  PubMed  Google Scholar 

  7. Schwenk W, Haase O, Neudecker J, Müller JM (2006) Short term benefits for laparoscopic colorectal resection (Cochrane Review).

  8. Hinchey EJ, Schall PGH, Richards GK (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109

    CAS  PubMed  Google Scholar 

  9. Hansen O, Graupe F, Stock W (1998) Diagnosis of diverticulitis in routine practise: progress due to pelvic CT. Langenbecks Arch Surg Suppl Kongressbd. 115:170–173

    CAS  Google Scholar 

  10. Redwine DB, Sharpe DR (1991) Laparoscopic segmental resection of the sigmoid colon for endometriosis. J Laparoendosc Surg 1:217–220

    Article  CAS  PubMed  Google Scholar 

  11. Fowler DL, White SA (1991) Laparoscopy-assisted sigmoid resection. Surg Laparosc Endosc 1:183–188

    CAS  PubMed  Google Scholar 

  12. Dwivedi A, Chahin F, Agrawal S, Chau WY, Tootla A, Tootla F, Silva YJ (2002) Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease. Dis Colon Rectum 45:1309–1314

    Article  PubMed  Google Scholar 

  13. Simon T, Orangio GR, Ambroze WL, Armstrong DN, Schertzer ME, Choat D, Pennington EE (2005) Factors associated with complications of open versus laparoscopic sigmoid resection for diverticulitis. JSLS 9:63–67

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Alves A, Panis Y, Slim K, Heyd B, Kwiatkowski F, Mantion G (2005) French multicentre prospective observational study of laparoscopic versus open colectomy for sigmoid diverticular disease. Br J Surg 92:1520–1525

    Article  CAS  PubMed  Google Scholar 

  15. Regenet N, Pessaux P, Tuech JJ, Hennekinne S, Lermite E, Ridereau-Zins C, Aube C, Bergamaschi R, Jean-Pierre A (2005) Prospective evaluation of the quality of laparoscopic sigmoid resection for diverticular disease. Hepatogastroenterology 52:1427–1431

    PubMed  Google Scholar 

  16. Schwandner O, Farke S, Bruch HP (2005) Laparoscopic colectomy for diverticulitis is not associated with increased morbidity when compared with non-diverticular disease. Int J Colorectal Dis 20:165–172

    Article  CAS  PubMed  Google Scholar 

  17. Sher ME, Agachan F, Bortul M, Nogueras JJ, Weiss EG, Wexner SD (1997) Laparoscopic surgery for diverticulitis. Surg Endosc 11:264–267

    Article  CAS  PubMed  Google Scholar 

  18. Pugliese R, Di LS, Sansonna F, Scandroglio I, Maggioni D, Ferrari C, Costanzi A, Chiara O (2004) Laparoscopic treatment of sigmoid diverticulitis: a retrospective review of 103 cases. Surg Endosc 18:1344–1348

    Article  CAS  PubMed  Google Scholar 

  19. 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

    Article  CAS  PubMed  Google Scholar 

  20. Vargas HD, Ramirez RT, Hoffman GC, Hubbard GW, Gould RJ, Wohlgemuth SD, Ruffin WK, Hatter JE, Kolm P (2000) Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis. Dis Colon Rectum 43:1726–1731

    Article  CAS  PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. Scheidbach H, Schneider C, Rose J, Konradt J, Gross E, Barlehner E, Pross M, Schmidt U, Kockerling F, Lippert H (2004) Laparoscopic approach to treatment of sigmoid diverticulitis: changes in the spectrum of indications and results of a prospective, multicenter study on 1,545 patients. Dis Colon Rectum 47:1883–1888

    Article  PubMed  Google Scholar 

  23. Marusch F, Gastinger I, Schneider C, Scheidbach H, Konradt J, Bruch HP, Kohler L, Barlehner E, Kockerling F (2001) Importance of conversion for results obtained with laparoscopic colorectal surgery. Dis Colon Rectum 44:207–214

    Article  CAS  PubMed  Google Scholar 

  24. Bartus CM, Lipof T, Sarwar CM, Vignati PV, Johnson KH, Sardella WV, Cohen JL (2005) Colovesical fistula: not a contraindication to elective laparoscopic colectomy. Dis Colon Rectum 48:233–236

    Article  PubMed  Google Scholar 

  25. Laurent SR, Detroz B, Detry O, Degauque C, Honore P, Meurisse M (2005) Laparoscopic sigmoidectomy for fistulized diverticulitis. Dis Colon Rectum 48:148–152

    Article  CAS  PubMed  Google Scholar 

  26. Menenakos E, Hahnloser D, Nassiopoulos K, Chanson C, Sinclair V, Petropoulos P (2003) Laparoscopic surgery for fistulas that complicate diverticular disease. Langenbecks Arch Surg 388:189–193

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany

    Christina Zapletal, Guido Woeste, Wolf O. Bechstein & Christoph Wullstein

Authors
  1. Christina Zapletal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guido Woeste
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wolf O. Bechstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christoph Wullstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christina Zapletal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zapletal, C., Woeste, G., Bechstein, W.O. et al. Laparoscopic sigmoid resections for diverticulitis complicated by abscesses or fistulas. Int J Colorectal Dis 22, 1515–1521 (2007). https://doi.org/10.1007/s00384-007-0359-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-007-0359-y

Keywords

Search

Navigation