Andrew Villarreal, Immanuel Gabriel, MD, PhD, Michelle K Savu, MD. South Texas VAHCS, San Antonio, TX; University of Texas Health Science Center, San Antonio, TX.
The treatment of diverticular disease has undergone a paradigm shift over the last decade. While many reports attest to the safety and benefits of laparoscopic treatment of acute and non-acute diverticular disease, it is difficult to ascertain the overall penetrance of its usage in general surgical practice. The objective of this study was to evaluate the usage of laparoscopic treatment of diverticular disease in a VA system general surgery service over a 10 year period of time.
Methods and procedures:
We performed a retrospective chart review of patients undergoing surgical intervention for diverticular disease at a single VAHCS institution between 2003 and 2013 documented in the CPRS EMR using CPT coding. Inclusion criteria included all patients who received either elective or acute surgical treatment for diverticular disease. Outcomes included age of intervention, BMI, diagnosis, and surgical technique. Statistical analysis was used student’s t-test with p<0.05 considered significant. IRB approval was obtained.
Between January 2003-September 2013, 93 patients underwent surgical intervention for diverticular disease. Of these, 96% were male (4:89 F: M) with an average age of 56 years old (range 29-86 y/o). Indications for surgical intervention included recurrent disease(51/94;55%), failed antibiotic treatment (2/93;2%), colovesicle/colovaginal fistula (9/93;9%), stricture(5/93;5%)bleeding (2/93;2%) and perforation(24/93;26%). There were 32 (34%) cases of non-elective surgical intervention for acute disease. In total 33/93(35%) cases were performed laparoscopically, while 61/93 (65%) were performed open. Of the open procedures, 14 (23%) were Hartmann procedures. Of the non-elective cases, 3/32 (9%) were performed laparoscopically, with the majority being performed open. In the elective cases, 30/61 (49%) were performed laparoscopically. In the first 5 years of the study 2003-2007, 11 of 45 (24%) cases were performed laparoscopically. In the last 5 years 2008-2013, 22 /48 (46%) procedures were performed laparoscopically (p<0.05).Between laparoscopic and open cases there were no statistical differences between age (54 vs. 57 p = NS) or BMI (p > 0.05).
In our single institutional study the majority of surgical interventions for diverticular disease, especially non-elective cases, are still performed with the open surgical technique. There is a significant increase in percentage of patients treated laparoscopically in the last half of the last decade (2008-2013) as compared to the first half ( 2003-2007). However, only 9% of the non-elective cases are performed laparoscopically. In conclusion, in our institute, the surgical intervention for diverticular disease is increasingly performed laparoscopically however open surgical technique is preferred for acute surgical management.