One Stage Left Colon Resection for Chronic and Acute Diverticulitis with Or Without Perforation

Ibrahim M Ibrahim, MD, Jeffrey W Strain, MD. ENGLEWOOD HOSPITAL & MEDICAL CENTER

Background: Historically the presence of peritonitis, severe phlegmon or localized abscess is considered cotraindications to primary colonic resection. Colonic anastomosis in the presence of purulence is thought to be at high risk for disruption and leak. One stage resection without a colostomy is clearly a more beneficial for the patient. We reasoned that improved perioperative care, better nutrition and antibiotics and the laparoscopic approach with preservation of the immune response would result in better outcome for one stage resection. Methodes: We reviewed our experience with all patients refered with a CT diagnosis of diverticulitis. There were 43 patients over 4.5 year period. All patients were operated on with the intent to perform one stage procedure. All acutely ill patients were treated with intravenous fluids and antibiotics for at least few hours. Patients with chronic diverticulitis underwent placement of bilateral ureteral catheters.All procedures were done in the lithotomy position. Anastomoses of normal descending colon to proximal rectum were done using EEA staplers. The anastomoses were tested either by air insufflation or sigmoidoscopy. Results: Two patients had perforated appendicitis. The remaining 41, nine had diverticular phlegmon, fourteen had acute perforations with varying degrees of peritonitis, 18 had chronic diverticulitis, 5 of whom had intra-abdominal and or pelvic abscesses. One patient developed minimal pneumoperitoneum 5 days postop and another had minimal abdominal collection. Both were treated with antibiotics and resolved. There were no deaths and no patient required reoperation. One patient developed recurrent diverticulitis in the descending colon few months later because of steroid use. She underwent further laparoscopic resection. One patient with chronic disease and prior pelvic and aortic nodal radiation for endometrial cancer had extremely friable tissues including the rectum. She required a Hartman procedure.Conclusions: One stage laparoscopic colonic resection for diverticular disease seems to be viable and safe. Removal of all diseased tissue and anastomosis of normal colon to normal rectum is crucial.