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International Journal of Colorectal Disease

Published in:

01-06-2017 | Original Article

Sigmoid resection for diverticulitis is more difficult than for malignancies

Authors: MAW Stam, WA Draaisma, PCM Pasker, ECJ Consten, IAMJ Broeders

Published in: International Journal of Colorectal Disease | Issue 6/2017

Abstract

Purpose

Sigmoid resection for diverticulitis is usually the first procedure performed when starting the learning process for laparoscopic colorectal surgery. The aim of this study is to evaluate the difficulty of laparoscopic sigmoid resection for diverticulitis in comparison to sigmoid malignancy in order to assess its role in the residents training program.

Methods

A cohort of patients was selected who suffered either from malignancy or recurrent diverticulitis in the sigmoid colon. Laparoscopic sigmoid resection was performed. The degree of difficulty was assessed by intraoperative complications and intraoperative technical challenges. Furthermore, take-overs from assistant to surgeon, surgeon to surgeon, and conversion were reported.

Results

A total of 224 patients were included, 119 (53.1%) men and 105 (46.9%) women.

Patients suffering from diverticulitis had significantly less co-morbidities than those with malignancies. In the diverticulitis group, there were significantly more technical challenges. There was a higher rate in take-overs from residents (p = 0.02) as well as surgeon to surgeon (p = 0.04). The rate of conversions was also significantly higher in the diverticulitis group (p = 0.03) when compared to the malignancy group.

Conclusions

The outcomes of our study show that diverticulitis may not be the ideal condition to start the learning process for laparoscopic colorectal surgery.

Bosker R, Hoogenboom F, Groen H, Hoff C, Ploeg R, Pierie JP (2013) Early learning effect of residents for laparoscopic sigmoid resection. J Surg 70:200–205

Leong S, Cahill RA, Mehigan BJ, Stephens RB (2007) Considerations on the learning curve for laparoscopic colorectal surgery: a view from the bottom. Int J Color Dis 22(9):1109–1115CrossRef

Klarenbeek BR, Veenhof AA, Bergamaschi R et al (2009) Laparoscopic sigmoid resection for diverticulitis decreases major comorbidity rates: a randomized control trial: short term results of the Sigma Trial. Ann Surg 249:39–44CrossRefPubMed

Klingensmith ME, Lewis FR (2013) General surgery residency training issues. Adv Surg 47:251–270CrossRefPubMed

Holmer C, Lehmann KS, Engelmann S et al (2011) Long-term outcome after conservative and surgical treatment of acute sigmoid diverticulitis. Langenbeck's Arch Surg 396(6):825–832CrossRef

Rafferty J, Shellito P, Hyman NH et al (2006) Standards Committee of American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis. Dis Colon rectum 49:939–944

Andeweg CS, Felt-Bersma R, Verbon A et al (2013) Summary of the practice guideline on diverticulitis in the colon: diagnostics and treatment in specialty care. Ned TijdschrGeneeskd 157(15):A6124

Naguib N, Masoud A (2013) Laparoscopic colorectal surgery for diverticular disease is not suitable for the early part of the learning curve. A retrospective cohort study. Int J Surg 11(10):1092–1096CrossRefPubMed

Quan H, Li B, Couris CM et al (2011) Updating and validating the Charlson Comorbidity Index and Score for risk asjustment in hospital discharge abtracts using data from 6 countries. Am J Epidemiol 173:676–682CrossRefPubMed

10.

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 Color Dis 20(2):165–172CrossRef

11.

Lee SW (2009) Laparoscopic procedures for colon and rectal surgery. Clin Colon Rectal Surg 22(4):218–224CrossRefPubMedPubMedCentral

12.

Nedrebo BS, Soreide K, Nesbakken A et al (2013) Risk factors associated with poor lymph node harvest after colon cancer surgery in a national cohort. Color Dis 15:e301–e308CrossRef

13.

Veen T, Nedrebo BS, Stormark K et al (2013) Qualitive and quantitive issues of lymph nodes as prognostic factors in colon cancer. Dig Surg 30(1):1–11CrossRefPubMed

14.

Yacoub M, Swistak S, Chan S et al (2013) Factors that influence lymph node retrieval in the surgical treatment of colorectal cancer: a comparison of the laparoscopic versus open approach. Am J Surg 205(3):339–342CrossRefPubMed

15.

Bamboat ZM, Deperalta D, Dursun A, Berger DL, Bordeianou L (2011) Factors affecting lymph node yield from patients undergoing colectomy for cancer. Int J Color Dis 26(9):1163–1168CrossRef

16.

Akmal Y, Bailey C, Baek J, Metchikian M, Pigazzi A (2011) Oncological outcomes of laparoscopic colon resection for cancer after implementation of a full-time preceptorship. Surg Endosc 25:2967–2971CrossRefPubMed

17.

Alves A, Panis Y, Mathieu P et al Prospective mortality and morbidity in French patients undergoing colorectal surgey: results of a prospective multicenter study. Arch Surg 140(3):278–283

18.

Kirchhoff P, Clavien PA, Hahnloser D (2010) Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg 4:5CrossRefPubMedPubMedCentral

19.

Kirchhoff P, Matz D, Dincler S et al (2011) Predictive risk factor for intra- and postoperative complications in 526 laparoscopic sigmoid resections due to recurrent diverticulitis: a multivariate analysis. World J Surg 35:677–683CrossRefPubMed

Title: Sigmoid resection for diverticulitis is more difficult than for malignancies
Authors: MAW Stam
WA Draaisma
PCM Pasker
ECJ Consten
IAMJ Broeders
Publication date: 01-06-2017
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 6/2017
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-017-2756-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sigmoid resection for diverticulitis is more difficult than for malignancies

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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