Laparoscopic Vs Open Colon Resection for the Treatment of Perforated or Complicated Diverticular Disease ( Hinchey Stage I and II )

[Background]: Diverticular disease affects more than half the Western population over the age of 60. Diverticulosis of the right colon is rare among Western people, whereas reports from Asia conclude that the occurrence of diverticula of the right colon but not of the left colon, has been increasing in recent years.
[Aim]: Elective laparoscopic surgery for recurrent, uncomplicated diverticular disease is considered safe and effective; however, little data exist on complicated cases. The aim of this study was to compare laparoscopic colon resection (LCR) with conventional open colon resection (OCR) for the treatment of perforated or complicated diverticular disease (HincheyI-II).
[Methods]: We reviewed the clinical records of 52 patients who underwent elective or emergency colon resection for complicated colon diverticulitis (Hinchey I~IV) between May 1994 and August 2007. Patients with Hinchey I diverticulitis underwent elective surgery, but those with Hinchey II, III, IV disease underwent emergency surgery. In patients with Hinchey IIa disease no percutaneous drainage of the abscess was performed before surgery. Of the 52 patients, 47 had undergone colon resection for Hinchey I and II disease. Thirty-three of these patients had undergone LCR, while 14 had undergone OCR. In the LCR group, the left colon was involved in 16 (48%) patients, and the right colon in 17 (52%). In the OCR group, the left colon was involved in 7 (50%) patients, and the right colon in 7 (50%). A five-trocar approach with minilaparotomy was used. Parameters were background factors, surgery, postoperative length of stay, and postoperative complications.
[Results]: The overall complication rate was significantly higher in the open group (incidence, 50%) than in the laparoscopic group (19.4%; p < 0.05). Wound infection was significantly more common in the open group (incidence, 42.9%) than in the laparoscopic group (12.9%; p < 0.05). No intraabdominal infection occurred in either group. Hospital stay was significantly shorter in the laparoscopic group (p < 0.05).
Intraoperative blood loss was significantly greater in the open group (p < 0.01).
[Conclusion]: Our findings indicate that laparoscopic surgery for colon diverticulitis in experienced hands is a safe and effective procedure even for patients with Hinchey I and II disease

Session: Poster

Program Number: P088