Acute Versus Elective Laparoscopic Sigmoid Resection for Diverticulitis

Marty Zdichavsky, MD, Tobias Meile, MD, Maximillian Von Feilitzsch, MD, Dörte Wichmann, MD, Alfred Königsrainer, MD. University Hospital Tuebingen, Germany

Objective:
Surgical treatment of acute sigmoid diverticulitis is still under debate while elective laparoscopic treatment has proven short-term benefits. The aim of this study was to evaluate the outcome of laparoscopic sigmoid colectomy in patients with acute diverticulitis.
Methods:
139 patients were retrospectively analysed. Indications for operation were acute complicated diverticulitis (Hansen and Stock IIa and IIb) and chronically recurrent diverticulitis with or without sigmoid stenosis (Hansen and Stock III). One-stage laparoscopic resection and primary anastomosis were routinely performed in a 3-trocar technique. Data recorded were age, sex, ASA-score, operative time, duration of hospital stay and complications.
Results:
Of 139 patients, 80 patients underwent elective laparoscopic sigmoid resection for diverticulitis (Group I) and 59 patients for acute diverticular disease (Group II). M:F ratio was 41:39 for Group I and 33:26 for Group II. In both groups females were older than males. Mean operative time was 173 min (range, 63-372 min) and 160 min (range, 60-370 min) for Group I and II, respectively. Majority of patients were ASA II in both groups. Mean postoperative hospital stay was equal for both groups. Minor complications were similar in both groups with 8.8%. Major complications with operative intervention were 1.7% for acute resection, but 5% for elective treatment. One anastomotic leak occurred in the elective group.
Conclusions:
Laparoscopic surgery for acute diverticular disease is safe and effective. For recurrent and complicated diverticulitis laparoscopic treatment should be recommended. Therapy regimen for perforated diverticulitis still needs more clinical trials for better evaluation.