Elective Laparoscopic Versus Open Colectomy for Symptomatic Diverticulosis – an Analysis of Acs-Nsqip Database

Venkata R Kakarla, MD, Dan E Ruiz, MD, Ambujakshan Dildeep, MD, Omar Bellorin-Marin, MD, Howard I Tiszenkel, MD. New York Hospital Queens, Flushing, NY

Background: The benefit of laparoscopic versus open colectomy for symptomatic colonic diverticulosis as an elective operation remains unclear. Our aim was to assess the 30-day outcomes after elective laparoscopic (LC) versus open colectomy (OC) and examine their association with the operative approach for this benign disease.

Methods: Using the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) participant-use file, patients were identified who underwent elective colon resection for symptomatic colonic diverticulosis, at the 211 participating hospitals between 2005 and 2008. Demographic, clinical, intra-operative variables and 30-day morbidity and mortality rates were collected. Logistic regression analysis was performed to determine the association between the surgical approach (LC vs OC) and risk-adjusted overall mortality, overall morbidity, serious morbidity and wound complications. The relationship between operative approach, operative duration and length of stay were also examined.

Results: We identified a total of 7629 patients that underwent colon resection for symtomatic diverticulosis. For comparative analysis, they were sub-divided into two groups – Open colectomy (OC, n 3,870 (50.7%)) and laparoscopic colectomy (LC, n 3759 (49.3%)). Patients who underwent OC were significantly older (59.0 vs 55.7 yrs, p <0.0001) with more comorbidities compared to those who underwent LC. After risk adjusted analysis it was noted that the patients treated with LC were less likely to experience overall morbidity (11.9% vs 23.2%), serious morbidity (4.6% vs 10.9%) and wound complications (9.1% vs 17.5%), but not mortality (0.3% vs 0.8%). Operative duration was significantly longer with LC (176.64 vs 166.70 mins, p < 0.0001) but the length of stay was significantly shorter (4.77 vs 7.68 days, p < 0.0001). On logistic regression analysis, patients that had history of peripheral vascular disease, percutaneous coronary interventions, current steroid use, and hypertension requiring medication, were at an increased risk of morbidity and mortality within 30 days. Patients that had history of chronic obstructive pulmonary disease and smoking experienced more wound complications by 30 days.

Conclusion: In elective setting, for symptomatic diverticulosis, LC appeared to be associated with lower morbidity and complications when compared to OC. However, no difference in mortality was noted between these two procedures.