Use and outcomes of emergent laparoscopic resection for acute diverticulitis
ABSTRACT The use and outcomes of laparoscopic sigmoid resection during emergency admissions for diverticulitis are unknown.
The Nationwide Inpatient Sample was queried for colorectal resections performed for diverticulitis during emergent hospital admissions (2003-2007). Univariate and multivariate analyses including patient, hospital, and outcome variables were performed.
A national estimate of 67,645 resections (4% laparoscopic) was evaluated. The rate of conversion to open operation was 55%. Ostomies were created in 66% of patients, 67% open and 41% laparoscopic. Laparoscopy was not a predictor of mortality (odds ratio [OR] =.70; confidence interval [CI], .32-1.53). Laparoscopy predicted routine discharge (OR = 1.31; CI, 1.06-1.63) and a decreased length of stay (absolute days = -.78; CI, -1.19 to -.37). There was no difference in the cost of hospitalization between the 2 groups (P = .45).
In acute diverticulitis, urgent laparoscopic resection decreases the length of stay. However, it is associated with a high conversion rate, no cost savings, and no difference in mortality.
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ABSTRACT: Laparoscopic surgery has become the standard of treatment for elective management of diverticular disease. However, its use in the acute setting remains controversial. The aim of this study is to compare the outcomes of laparoscopic surgery with open surgery in the acute management of complicated diverticular disease that failed initial medical treatment. This is a single-center comparative retrospective cohort study. Patients undergoing surgery for complicated diverticular disease after an attempt at medical treatment from 2000 to 2011 were selected. Laparoscopic versus open surgery was compared. The primary outcomes were overall 30-day morbidity and mortality. Secondary outcomes were length of stay, time to resume diet, and need for a permanent stoma. Forty-two patients were identified by using medical records: 24 laparoscopic surgery and 18 open surgery. Baseline demographics, ASA classification, Acute Physiology and Chronic Health Evaluation scores, Hinchey classification, and Charlson Comorbidity Index did not differ between groups. The mean operative time was 36 minutes longer (p = 0.05) and blood loss was 460 mL less (p < 0.001) for laparoscopic surgery. Two patients (8.3%) in the laparoscopic surgery group required conversion to open surgery. There was no mortality. Overall morbidity was lower favoring laparoscopic surgery (16.7% vs 55.6%; p = 0.01). Two patients in the laparoscopic surgery group experienced an anastomotic leak compared with none in the open surgery group. Mean time to resume diet (3 vs 6.5 days; p < 0.01) and length of stay (5 vs 8 days; p = 0.04) were shorter for the laparoscopic surgery group. Rate of permanent stoma at last follow-up (median, 332 days) did not differ significantly between groups. This study is limited by selection bias. Compared with open surgery, laparoscopic surgery for patients in whom medical treatment for complicated diverticular disease failed is associated with favorable outcomes, including a reduced rate of morbidity and a shorter length of stay. When applied to selected patients, this approach appears to be a safe procedure with a low rate of conversion.Diseases of the Colon & Rectum 12/2013; 56(12):1395-402. DOI:10.1097/DCR.0b013e3182a760b6 · 3.20 Impact Factor
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ABSTRACT: A minimally invasive approach to the management of diverticular disease has gained acceptance over the last number of years. Certainly, in the elective setting, laparoscopic sigmoid resection compares favourably with open surgery. The use of laparoscopy in the context of emergency surgery for complicated diverticular disease remains controversial however recent studies have demonstrated a defined role for laparoscopy in the acute setting.Best practice & research. Clinical gastroenterology 02/2014; 28(1):175-182. DOI:10.1016/j.bpg.2013.11.014 · 3.28 Impact Factor
Article: Z Gastroenterol. 2014 Jul;52(7):663-710. doi: 10.1055/s-0034-1366692. Epub 2014 Jul 15. [S2k guidelines diverticular disease/diverticulitis]. [Article in German] Leifeld L, Germer CT, Böhm S, Dumoulin FL, Häuser W, Kreis M, Labenz J, Lembcke B, Post S, Reinshagen M, Ritz JP, Sauerbruch T, Wedel T, von Rahden B, Kruis W.Zeitschrift für Gastroenterologie 07/2014; 52(7):663. DOI:10.1055/s-0034-1366692 · 1.67 Impact Factor