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Hand-assisted Laparoscopic Sigmoid Colectomy is Effective for Patients With Diverticulitis regardless of Disease Severity
Fadwa Ali*1, Irena Gribovskaja-Rupp1, Mohammad Mahmoud 2, Timothy J. Ridolfi1, Kirk Ludwig 1
1Medical College of Wisconsin, Milwaukee, WI; 2Surgery, University of Illinois Metropolitan Group Hospitals, Chicago, IL
Introduction: Laparoscopic sigmoid resection for diverticular disease is a challenging operation with conversion rates up to 24%, with many patients, perhaps, not offered a laparoscopic resection due to perceived complexity. Hand-assisted laparoscopic surgery may reduce conversion rates and make more patients candidates for a laparoscopic sigmoid resection. The aim of this study is to establish whether a standardized hand assisted laparoscopic approach results in low rates of complications and conversion regardless of disease severity.
Methods: This is a retrospective review of a prospectively maintained database of patients that underwent elective sigmoid resection for diverticular disease from 2008 to 2012 at a tertiary care, teaching hospital. Intraoperative findings, conversion rates and post-operative complications were analyzed. Statistical analysis was performed using Student’s t-test and Fischer’s exact test, with p< 0.05 being significant.
Results: Fifty-eight patients underwent sigmoid resection for diverticular disease during the study period, with all offered a hand assisted laparoscopic sigmoid resection: 43% had complicated diverticulitis. Mean operative time was 165±4.4 minutes and the conversion rate was 3% overall. Mean time to return of bowel function was 2.8±0.1 days and the mean length of hospital stay was 4.3±0.2 days. Complication rate was 16%. Complications included ileus, urinary tract infections, wound seromas and superficial surgical site infections. No major complications including anastomotic leaks, cardiac or respiratory events were encountered. When the complicated diverticulitis group (n=25) was compared to the simple diverticulitis group (n=33), the complicated diverticulitis group had significantly longer operative times, more blood loss, and longer hospital stay. However, there were no differences in complication or conversion rates when comparing patients with simple and complicated diverticular disease. (Table 1)
Conclusion: Hand-assisted laparoscopic sigmoid colectomy for diverticulitis is associated with a low conversion rate even in patients with complicated diverticular disease.
Comparison of demographic, clinical and operative data between patients with simple and complicated diverticular disease
| | Simple Diverticular Disease
N=33 | Complicated Diverticular Disease
N=25 | P value | | Age | 55.2±1.95 | 58.9±2.7 | 0.25 | | Sex (%male) | 39 | 48 | N/A | | Operative Time (minutes) | 155.1±4.5 | 179.6±7.6 | 0.005* | | Estimated Blood Loss (ml) | 68.2±9.2 | 164.3±5.7 | 0.0001* | | Conversion to open | 0 | 2 (8%) | 0.18 | | Complications | 3 (9%) | 6 (24%) | 0.15 | | Return of bowel function (days) | 2.63±0.13 | 3.1±0.3 | 0.12 | | Length of Hospital Stay (days) | 3.9±0.25 | 4.8±0.3 | 0.02* |
Quantitative Data are expressed as the mean ±SEM. *Values are significantly different (P< 0.05).
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