OUTCOMES OF MINIMALLY INVASIVE COLECTOMY FOR PERFORATED DIVERTICULITIS
Zhobin Moghadamyeghaneh*1, Henry Talus1, Michael J. Stamos2, Valery Roudnitsky1
1Surgery, State University of New York, Downstate, Brooklyn, NY; 2University of California, Irvine, Irvine, CA
Background: We speculated that a laparoscopic approach to sigmoidectomy for perforated diverticulitis would be associated with less morbidity & mortality, and shorter hospitalization length compared to open approach. We aimed to compare outcomes of emergent laparoscopic and open sigmoidectomy with end colostomy for perforated diverticulitis using data from the National Surgical Quality Improvement Program (NSQIP) database for the period 2012 - 2017.
Methods: The NSQIP database was used to investigate adult patients who underwent emergent sigmoidectomy with end colostomy for perforated diverticulitis. Multivariate analysis using logistic regression was used to compare outcomes of patients by surgical approach.
Results: We found a total of 2,937 adult patients who underwent emergent Hartman procedure for perforated diverticulitis during 2012-2017. The rate of minimally invasive surgery (MIS) was 11.4% with 38.6% conversion rate to open. The rate of MIS approach increased from 9.2% for 2012 to 13% for 2017. The 30 days post-operative mortality and morbidity rates were 8.8% and 65.8% respectively. Following adjustment using multivariate analysis MIS approach associated with decreased in morbidity of patients (56.8% vs. 67.2%, AOR: 1.70, P<0.01) There was not any significant difference in risk of reoperation (3.9% vs. 8.5%, AOR: 01.06, P=0.79), and intra-abdominal abscess (10.2% vs. 11.6%, AOR: 1.12, P=0.59) of patients who underwent open vs. MIS approach. Respiratory complications of ventilator dependency (6% vs. 14.3%, AOR: 2.95, P<0.01) and unplanned intubation (2.4% VS. 7.4%, AOR: 2.14, P=0.03) significantly decreased using MIS approach. Mean hospitalization length of patients significantly decreased using MIS approach (10 days vs. 13 days, P<0.01). Although conversion to open increases morbidity of patients compared to successfully completed MIS operations (AOR:2.47 , P<0.01), such patients didn’t have higher morbidity risk compared to patients who had planned open procedures (AOR:0.89, P=0.57).
Conclusion: The MIS approach to emergent partial colectomy for perforated diverticulitis when feasible is associated with decreased morbidity and hospitalization length of patients. Utilization of MIS approach to partial colectomy for perforated diverticulitis is 11.4% with an increasing rate over time. Conversion to open is common (38.6%) but conversion does not increase mortality and morbidity of patients.
Back to 2020 Abstracts