Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic sigmoid colectomy for complicated diverticulitis is safe: review of 576 consecutive colectomies

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Laparoscopic resection of diverticular disease is typically offered to selected patients. We present the outcomes of laparoscopic colectomy in consecutive patients suffering from either simple diverticulitis (SD) or complicated diverticulitis (CD).

Purpose

To examine the outcomes of laparoscopic sigmoid colectomy for complicated diverticulitis.

Methods

Between December 2001 and May 2013, all patients with diverticulitis requiring elective operation were offered laparoscopic sigmoid colectomy as the initial approach. All cases were managed at a large tertiary care center on the colorectal surgery service. Preoperative, intraoperative, and postoperative variables were prospectively entered into the colorectal surgery service database (CRSD) and analyzed retrospectively.

Results

Of the 576 patients in the CRSD, 139 (24.1 %) had CD. The overall conversion rate was 12.8 % (n = 74). The average BMI was 29.8 kg/m2. The conversion rate for CD was 12.2 %. The return of bowel function time was delayed in the CD group when compared to the SD group (3.1 vs 3.8 days, p = 0.04). The hospital length of stay (HLOS) was similar between the groups (5.1 vs 5.8 days, p = 0.08). The overall anastomotic leak rate was 2.1 % (n = 12). Patients undergoing laparoscopic resection for SD had a postoperative complication rate of 10.0 % (n = 38), whereas those with CD had a postoperative morbidity rate of 19.6 % (n = 24). CD patients who had conversion to an open procedure had an even higher rate of postoperative complications (29.4 %, n = 5, p = 0.35). On non-parsimonious multivariate adjustment, only CD (RR 1.96, 95 % CI 1.11–3.46, p = 0.02) was found to be an independent risk factor for the development of postoperative complications.

Conclusions

Complicated diverticulitis did not affect the conversion rate to an open procedure. However, patients with CD are prone to postoperative complications. The laparoscopic approach to sigmoid colectomy is safe and preferable in experienced hands.

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
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Corman ML (2005) Colon and rectal surgery, 5th edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  2. Feingold D, Steele SR, Lee S et al (2014) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 57(3):284–294

    Article  PubMed  Google Scholar 

  3. Parks TG (1969) Natural history of diverticular disease of the colon. A review of 521 cases. Br Med J 4(5684):639–642

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bartus CM, Lipof T, Sarwar CM et al (2005) Colovesical fistula: not a contraindication to elective laparoscopic colectomy. Dis Colon Rectum 48(2):233–236

    Article  PubMed  Google Scholar 

  5. Scheidbach H, Schneider C, Rose J et al (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(11):1883–1888

    Article  PubMed  Google Scholar 

  6. Bouillot JL, Berthou JC, Champault G et al (2002) Elective laparoscopic colonic resection for diverticular disease: results of a multicenter study in 179 patients. Surg Endosc 16(9):1320–1323

    Article  CAS  PubMed  Google Scholar 

  7. Senagore AJ, Stulberg JJ, Byrnes J, Delaney CP (2009) A national comparison of laparoscopic vs. open colectomy using the National Surgical Quality Improvement Project data. Dis Colon Rectum 52(2):183–186

    Article  PubMed  Google Scholar 

  8. Carbajo MA, Martin del Olmo JC, Blanco JI et al (1999) Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13(3):250–252

    Article  CAS  PubMed  Google Scholar 

  9. Kuhry E, Saetnan E, Graeslie H, Gaupset R (2007) Laparoscopic surgery for colorectal cancer. Tidsskrift for den Norske laegeforening:tidsskrift for praktisk medicin, ny raekke. 127(22):2946–2949

    PubMed  Google Scholar 

  10. Hassan I, Cima RR, Larson DW et al (2007) The impact of uncomplicated and complicated diverticulitis on laparoscopic surgery conversion rates and patient outcomes. Surg Endosc 21(10):1690–1694

    Article  PubMed  Google Scholar 

  11. Gervaz P, Pikarsky A, Utech M et al (2001) Converted laparoscopic colorectal surgery. Surg Endosc 15(8):827–832

    Article  CAS  PubMed  Google Scholar 

  12. Faynsod M, Stamos MJ, Arnell T, Borden C, Udani S, Vargas H (2000) A case–control study of laparoscopic versus open sigmoid colectomy for diverticulitis. Am Surg 66(9):841–843

    CAS  PubMed  Google Scholar 

  13. Sher ME, Agachan F, Bortul M, Nogueras JJ, Weiss EG, Wexner SD (1997) Laparoscopic surgery for diverticulitis. Surg Endosc 11(3):264–267

    Article  CAS  PubMed  Google Scholar 

  14. Collins D, Winter DC (2014) Laparoscopy in diverticular disease: controversies. Best Pract Res Clin Gastroenterol 28(1):175–182

    Article  PubMed  Google Scholar 

  15. Kockerling F, Schneider C, Reymond MA et al (1999) Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group. Surg Endosc 13(6):567–571

    Article  CAS  PubMed  Google Scholar 

  16. Chapman J, Davies M, Wolff B et al (2005) Complicated diverticulitis: is it time to rethink the rules? Ann Surg 242(4):576–581; discussion 581-573

  17. Turley RS, Barbas AS, Lidsky ME, Mantyh CR, Migaly J, Scarborough JE (2013) Laparoscopic versus open Hartmann procedure for the emergency treatment of diverticulitis: a propensity-matched analysis. Dis Colon Rectum 56(1):72–82

    Article  PubMed  PubMed Central  Google Scholar 

  18. Liberman MA, Phillips EH, Carroll BJ, Fallas M, Rosenthal R (1996) Laparoscopic colectomy vs traditional colectomy for diverticulitis. Outcome and costs. Surg Endosc 10(1):15–18

    Article  CAS  PubMed  Google Scholar 

  19. Caputo D, Caricato M, La Vaccara V, Capolupo GT, Coppola R (2014) Conversion in mini-invasive colorectal surgery: the effect of timing on short term outcome. Int J Surg 12(8):805–809

    Article  PubMed  Google Scholar 

  20. Keller DS, Bankwitz B, Woconish D et al (2014) Predicting who will fail early discharge after laparoscopic colorectal surgery with an established enhanced recovery pathway. Surg Endosc 28(1):74–79

    Article  PubMed  Google Scholar 

  21. Blake MF, Dwivedi A, Tootla A, Tootla F, Silva YJ (2005) Laparoscopic sigmoid colectomy for chronic diverticular disease. J Soc Laparoendosc Surg 9(4):382–385

    Google Scholar 

  22. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242(1):83–91

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Albany Medical College, 43 New Scotland Avenue, Mail Code MC-194, Albany, NY, 12208-3479, USA

    Avinash Bhakta, Marcel Tafen, Owen Glotzer, Jonathan Canete, A. David Chismark, Brian T. Valerian, Steven C. Stain & Edward C. Lee

Authors
  1. Avinash Bhakta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcel Tafen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Owen Glotzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathan Canete
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. David Chismark
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Brian T. Valerian
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Steven C. Stain
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Edward C. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Avinash Bhakta.

Ethics declarations

Disclosures

Drs. Avinash Bhakta, Marcel Tafen, Owen Glotzer, Jonathan Canete, A. David Chismark, Brian T. Valerian, Steven C. Stain, and Edward C. Lee have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhakta, A., Tafen, M., Glotzer, O. et al. Laparoscopic sigmoid colectomy for complicated diverticulitis is safe: review of 576 consecutive colectomies. Surg Endosc 30, 1629–1634 (2016). https://doi.org/10.1007/s00464-015-4393-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4393-5

Keywords

Search

Navigation