Laparoscopic Treatment of Diverticulitis. Have We Learned Something?

Christopher W Salzmann, MD, Morris E Franklin, MD FACS, Karla Russek, MD. Texas Endosurgery Institute


* History
-50’s: Lavagae and drainage
-60’s: Resection after second episode, 2 stages (Hartmann’s + Resection)
-70’s: No changes
-80’s: First lap cholecystectomy
90’s: First Lap colon resection
-5-10% over 45 years
-40% 60 years
-80% over 85 years
*Modified Hinchey Classification
-I: Pericolic abscess
-IIA: Distant abscess amenable to percutaneous drainage
-IIB: Complex abscess associated with fistula
-III: Generalized purulent peritonitis
-IV: Fecal peritonitis
*Laparoscopic or open resection of diverticular disease may be quite challenging
*When to perform surgery? *** all can be performed laparoscopically ***
-Drainage of abscess not ammendable to CT Drainage
-Necessary colonic resection
-Large un-resolving phlegmon
-Complications of diverticulitis (not responding to medical management)
*Chances of converting to open colectomy
-4.8% rate in Hinchey I-II, 18.2% rate of conversion for cases of complicated diverticulitis (Hinchey III-IV)
-Causes of conversion: Hemorrhage in mesentery, fibrosis, severe inflammation, adhesions, anatomy not defined
-Placement of diversion (ileo-colostomy)
-Examination and lavage of peritoneal cavity
-Laparoscopic colon surgery is a valid alternative for the treatment of acute and chronic diverticulitis.
-There is documented success with both laparoscopic colectomy as well as laparoscopic peritoneal lavage and drainage.
-The applicability of laparoscopic colonic surgery will remain directly dependent upon the individual surgeon’s laparoscopic skills.
-In experienced hands, laparoscopic sigmoid colectomy for diverticulitis is as good or better than open colectomy.
-The most common indication for surgery in our practice is patient with chronic refractory disease which summarily interferes with the lifestyle of the patient.
-Patients with complicated, perforated (localized) diverticulitis rarely require urgent surgery.
-The presence of diverticulitis does not necessary means that surgery is needed immediately or ultimately.
-Close followup and patient education…. mandatory!!
-Large number of patients, even with perforation can be treated without resection.

Session Number: Poster – Poster Presentations
Program Number: P054
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