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Laparoscopic versus Open Emergent Sigmoid Resection for Perforated Diverticulitis

Yongjin F Lee, MD, June Hsu, MD, Michael Battaglia, MS, Robert K Cleary, MD. St. Joseph Mercy Ann Arbor

INTRODUCTION: The role of the laparoscopic approach to emergent resection for diverticulitis is unclear. Previous studies have demonstrated its safety and feasibility. There is a need for a large risk-adjusted database analysis of emergent operations for Hinchey III or IV diverticulitis that focuses on the role for minimally invasive options. The objective of this study is to compare outcomes between the laparoscopic and open approach to emergent sigmoidectomy for perforated diverticulitis.

METHODS AND PROCEDURES: The national American College of Surgeons-National Surgical Quality Program (ACS-NSQIP) database was queried for cases of laparoscopic and open emergent sigmoid resection for perforated diverticulitis from January 1, 2012 through December 31, 2016. Propensity scores were converted to weights and weighted generalized linear models created. 30-day outcomes were compared between emergent laparoscopic and open sigmoidectomy. Two subgroup analyses were performed comparing 1) laparoscopic to open Hartmann’s procedure, and 2) laparoscopic to open sigmoidectomy with primary anastomosis and diverting stoma.

RESULTS: 2,845 patients were included in the study – 2,581 open, and 264 laparoscopic sigmoidectomy. Compared to the laparoscopic approach, open sigmoidectomy had a higher rate of complications overall (p < 0.001), and a longer hospital length of stay (p < 0.001). Specifically, the open approach had higher rates of ileus (p = 0.003), acute renal failure (p < 0.001), unplanned intubation (p < 0.001), superficial SSI (p < 0.001) ), re-operation within 30 days (p = 0.04), and discharge destination other than home (p < 0.001). Mortality rate favored the laparoscopic to open approach (2.99% vs. 6.97%, respectively), although this difference was not statistically significant (p = 0.089).  Subgroup analyses showed similar findings. 2,007 patients underwent open and 152 patients underwent laparoscopic Hartmann’s procedure. Compared to laparoscopic, open Hartmann’s had an overall higher rate of complications (p < 0.001), including a higher rate of acute renal failure (p < 0.001), pneumonia (p = 0.02), unplanned intubation (p < 0.001) and superficial SSI (p < 0.001). Mortality was higher but not statistically significant following open compared to laparoscopic Hartmann’s (7.35% vs. 2.09%, p = 0.07). Subgroup analysis comparing laparoscopic and open sigmoidectomy with primary anastomosis and diverting stoma favored the laparoscopic approach, although it was limited by sample size (n = 10 and 85, respectively).

CONCLUSION: The laparoscopic approach has better outcomes than the traditional open approach in emergent sigmoid resection for perforated diverticulitis. Additional studies are needed to confirm this finding in a randomized controlled setting.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94266

Program Number: P272

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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