Minimally invasive colectomy for complicated diverticular disease in the emergency setting: A safe choice?

Francois Letarte, MD, Hallet Julie, MD, Roger C Gregoire, MD, FRSCS, Jean-Pierre Gagne, MD, FRSCS, Alexandre Bouchard, MD, FRSCS, Drolet Sebastien, MD, FRSCS, Philippe Bouchard, MD, FRSCS, Claude Thibault, MD, FRSCS

Hôpital Saint-Francois d’Assise, CHUQ

INTRODUCTION- Although minimally invasive surgery has now been proven to be the standard of treatment in elective cases of diverticular disease, very few studies have analysed its role in non-elective cases. The objective of this study is to prove that MIS is a safe and feasible option in the treatment of complicated diverticular disease in the emergency setting.

METHODS AND PROCEDURES- Consecutive patients who underwent emergent colectomy for complicated diverticular disease from 2000 to 2011 in a single academic center were analysed from a retrospectively collected database. Morbidity and outcomes were compared between patients who had minimally invasive surgery (MIS) versus those who had open surgery (OS). A second analysis was planned for the sub-group of patients surgically treated because of failure of the medical management.

RESULTS- A total of 125 patients were analysed, 39 in the MIS cohort and 86 in the OS cohort. Both cohorts were comparable in terms of age, BMI, ASA and APACHE score. There was a higher proportion of Hinchey III complicated diverticulitis in the OS cohort (47.4% vs 21.9%). Operating time was longer in the MIS cohort (273.6 min vs 241.8 min) but blood losses (170.6 cc vs 441.9 cc), primary anastomosis (84.6% vs 54.6%), overall morbidity (26.6% vs 52.3%), length of hospital stay (5 vs 8 days), time to normal diet (3 vs 6 days), mortality (0 vs 4 deaths) and permanent stomas (5.1% vs 13.9%) all significantly favoured the MIS cohort. Anastomotic leaks were similar in both cohorts (5.1% vs 3%) and only two laparoscopic resections required conversion to open surgery. A sub-group of patients (24 in the MIS cohort vs 18 in the OS cohort) in whom medical treatment failed and had to undergo surgery, was also analysed. Results showed the same benefits in the MIS cohort. In that case, cohorts were comparable in terms of Hinchey classification.

CONCLUSION- Minimally invasive surgery seems to be a safe and feasible option in the treatment of complicated diverticular disease in the emergency setting in selected patients. Results of our study suggest that the benefits associated with laparoscopic colectomy found in comparative studies of elective cases could be applied to urgent complicated cases.

Session: Podium Presentation

Program Number: S070

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