Skip to main content

Advertisement

SpringerLink
Log in

Can laparoscopically assisted sigmoid resection provide uncomplicated management even in cases of complicated diverticulitis?

  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

Laparoscopically assisted sigmoid resection has become an accepted method for treating uncomplicated diverticulitis. This prospective study aimed to compare the results of laparoscopic sigmoid resection for uncomplicated and complicated sigmoid diverticular disease used to check the indication for the complicated stages of diverticulitis.

Methods

All patients who underwent laparoscopic resection for sigmoid diverticulitis at the authors’ hospital between 1999 and 2005 were divided into two groups: group 1 (uncomplicated diverticular disease) and group 2 (complicated diverticular disease). The exclusion criteria specified generalized peritonitis, signs of sepsis, and extensive previous abdominal surgery.

Results

Of the 203 patients (108 men and 95 women) who underwent laparoscopically assisted resection during the examination period, 112 were assigned to group 1 and 91 to group 2. Differences in favor of group 1 were found for the duration of surgery (154 vs 166 min), the conversion rate (1.8% vs 9.9%), the postoperative wound infections (2.7% vs 13.2%), and the postoperative hospitalization period (12.3 ± 3.9 vs 15.0 ± 5.6 days). No significant differences were seen in any other areas such as completion of nutritional buildup (4.6 vs 5.0 days) or time until the first postoperative bowel movement (2.8 vs 3.3 days). Total postoperative morbidity (16.1% vs 26.4%; p = 0.10) tended to be increased in group 2, but this difference was not statistically significant.

Conclusions

Laparoscopic sigmoid resection can be performed for patients who have complicated diverticulitis without significantly increasing their overall morbidity. This group of patients could benefit from the advantages of the minimally invasive procedure despite a longer operating time and a higher conversion rate.

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

CT scan 1
CT scan 2

Similar content being viewed by others

References

  1. Bouillot JL, Aouad K, Badawy A, Alamowitch B, Alexandre HJ (1998) Elective laparoscopic-assisted colectomy for diverticular disease: a prospective study in 50 patients. Surg Endosc 12: 1393–1396

    Article  CAS  Google Scholar 

  2. Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C (2002) Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory? A prospective study of 118 patients. Dis Colon Rectum 45: 962–966

    Article  PubMed  CAS  Google Scholar 

  3. Farmakis N, Tudor RG, Keighley RG (1994) The 5-year natural history of complicated diverticular disease. Br J Surg 81: 733–735

    CAS  Google Scholar 

  4. Franklin Jr ME, Dorman JP, Jacobs M, Plasencia G (1997) Is laparoscopic surgery applicable to complicated colonic diverticular disease? Surg Endosc 11: 1021–1025

    Article  Google Scholar 

  5. Germer CT, Buhr HJ (2002) Sigmoid diverticulitis: surgical indications and timing. Chirurg 73: 681–689

    Article  PubMed  CAS  Google Scholar 

  6. Gonzales 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

    Article  Google Scholar 

  7. Hansen O, Stock W (1999) Prophylaktische Operation bei der Divertikelkrankheit des Kolons: Stufenkonzept durch exakte Stadieneinteilung. Langenbecks Arch Chir Suppl II: 1257

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

  9. Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1: 144–150

    PubMed  CAS  Google Scholar 

  10. Jun S, Stollmann N (2002) Epidemiology of diverticular disease. Best Pract Res Clin Gastroenterol 16: 529–542

    Article  PubMed  Google Scholar 

  11. Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183: 630–641

    Article  PubMed  Google Scholar 

  12. Köckerling F, Schneider C, Reymond MA, Scheidbach H, Scheuerlein H, Konradt J, Bruch HP, Zornig C, Köhler L, Bärlehner L, 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  PubMed  Google Scholar 

  13. Köhler L (1999) Endoscopic surgery: what has passed the test? World J Surg 23: 816–824

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  15. 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 

  16. Marusch F, Gastinger I, Schneider C, Scheidbach H, Konradt J, Bruch HP, Köhler L, Bärlehner E, Köckerling F, Laparoscopic Colorectal Surgery Study Group (LCSSG) (2001) Importance of conversion for results obtained with laparoscopic colorectal surgery. Dis Colon Rectum 44: 207–214

    Article  PubMed  CAS  Google Scholar 

  17. Parks TG (1975) Natural history of diverticular disease of the colon. Clin Gastroenterol 4: 53–69

    PubMed  CAS  Google Scholar 

  18. Rose J, Schneider C, Yildirim C, Geers P, Scheidbach H, Köckerling F (2004) Complications in laparoscopic colorectal surgery: results of a multicentre trial. Tech Coloproctol 8: s25–s28

    Article  PubMed  Google Scholar 

  19. Scheidbach H, Schneider C, Rose J, Konradt J, Gross E, Bärlehner E, Pross M, Schmidt U, Köckerling 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 

  20. Schiedeck TH, Schwandner O, Bruch HP (1998) Laparoscopic sigmoid resection in diverticulitis. Chirurg 69: 846–853

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  22. 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  PubMed  CAS  Google Scholar 

  23. Schwandner O, Schiedeck TH, Bruch HP (1999) The role of conversion in laparoscopic colorectal surgery: do predictive factors exist? Surg Endosc 13: 151–156

    Article  PubMed  CAS  Google Scholar 

  24. Siriser F (2004) Laparoscopic-assisted colectomy for diverticularsigmoiditis: a single-surgeon prospective study of 65 patients. Surg Endosc 13: 811–813

    Article  Google Scholar 

  25. Trebuchet G, Lechaux D, Lecalve JL (2002) Laparoscopic left colon resection for diverticular disease. Surg Endosc 16: 18–21

    Article  PubMed  CAS  Google Scholar 

  26. Vargas HD, Ramirez RY, 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  PubMed  CAS  Google Scholar 

  27. Wilmore DW, Kehlet H (2001) Management of patients in fast track surgery. BMJ 322: 473–476

    Article  PubMed  CAS  Google Scholar 

  28. Wong WD, Wexner SD, Lowry A, Vernava A, Burnstein M, Denstman F, Fazio V, Kerner B, Moore R, Oliver G, Peters W, Ross T, Senatore P, Simmang C (2000) Practice parameters for the treatment of sigmoid diverticulitis: supporting documentation. Dis Colon Rectum 43: 290–297

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General, Vascular and Thoracic Surgery, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12200, Germany

    C. Reissfelder, H. J. Buhr & J.-P. Ritz

Authors
  1. C. Reissfelder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. J. Buhr
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J.-P. Ritz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Reissfelder.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reissfelder, C., Buhr, H.J. & Ritz, JP. Can laparoscopically assisted sigmoid resection provide uncomplicated management even in cases of complicated diverticulitis?. Surg Endosc 20, 1055–1059 (2006). https://doi.org/10.1007/s00464-005-0529-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-005-0529-3

Keywords

Search

Navigation