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01-04-2016

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

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

Published in: Surgical Endoscopy | Issue 4/2016

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.

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Title: Laparoscopic sigmoid colectomy for complicated diverticulitis is safe: review of 576 consecutive colectomies
Authors: Avinash Bhakta
Marcel Tafen
Owen Glotzer
Jonathan Canete
A. David Chismark
Brian T. Valerian
Steven C. Stain
Edward C. Lee
Publication date: 01-04-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4393-5

At a glance: The STEP trials

Springer Medicine

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

Abstract

Introduction

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Purpose

Methods

Results

Conclusions

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