Laparoscopic primary resection with anastomosis in acute colonic diverticulitis

Martin Galvarini, Francisco Schlottmann, Ezequiel Sadava, Alejandro Sanchez Ruiz, Manuel Maya, Maximiliano Bun, Nicolas Rotholtz. Hospital Aleman of Buenos Aires

Introduction: Although Hartmann´s procedure has been the standard treatment in patients with peritonitis due to diverticulitis, there are some studies showing the potential benefit of the one stage resection with primary anastomoses (PRA). However, this evidence is still weak.  The aim of this study was to evaluate the results of laparoscopic PRA in patients with acute perforated diverticulitis in a single institution.

Methods and procedures: From January 2000 to June 2013 all charts of consecutive patients who underwent a laparoscopic PRA for acute diverticulitis Hinchey III and IV were revised. These patients were enrolled in Group 1 (G1). Patients underwent to elective laparoscopic sigmoidectomy due to recurrent diverticulitis were used as a control group (G2). Demographics, clinical variables and perioperative complications were compared between both groups.  

Results: A total of 266 patients were included, 65 patients (25 %) in G1 and 201 (75 %) in G2. There were no differences in age, gender, BMI and ASA score between the two groups. The mean operative time was 193 minutes in G1 and 155 minutes in G2 (p: NS). Intraoperative complication rate was 7% in G1 and 3% in G2 (p: NS). Conversion rate was higher in G1 (G1 vs. G2: 20% and 4 %, p: 0.01). The length of hospital stay was 4.7 (2-20) days in G1 and 3.3 (2-17) days in G2 (p: NS). Clavien I-II complications occurred in 11 (16 %) patients in G1 and in 38 (18 %) patients in G2 (p: NS). Anastomotic leak rate was 4.6 % in G1 and 6 % in G2 (p: NS). There was no mortality in the series.

Conclusions: Laparoscopic PRA in patients with acute complicated diverticulitis seems to be safe and feasible. Prospective investigations with larger series are required to confirm these findings

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