Introduction: Laparoscopic treatment of diverticulitis is challenging because of its inflammatory nature. In the United States, many surgeons advocate a hand-assisted laparoscopic approach routinely for the treatment of these cases. We present the experience with a laparoscopic approach using hand-assisted surgery as needed, focusing on completion rate, morbidity, mortality and patient outcomes.
Methods: Since 1996, data regarding all patients undergoing laparoscopic colon resections has been prospectively entered into a database. Demographics and perioperative information were captured. The database was queried for all patients who underwent laparoscopic colectomy for diverticulitis from 01/98 to 07/07.
Results: 135 patients were treated, 70 were women. Mean age was 58 years (34-91 y.o.) and 79 patients (59%) had BMI >=25. Hinchey classification is as follow: Class 0: 5 (4%), class 1a: 49 (36%), class 1b: 45 (33%), class 2: 32 (24%), class 3: 32 (24%). 60% of patients had complicated diverticulitis. 4% of patients had abscesses percutaneously drained. Ureteral stents were used in 28 patients. Procedures: left colectomy n= 124 patients (92%), total colectomies n=9, (7%) and 2 right sided colectomies (1%). In 72% of cases 3 trocars were used, 4 trocars were used in 22% and 5 in 6%. Conversion rate was 3.7%, and consisted of conversion to hand-assisted laparoscopy, none were converted entirely to open. Clears were tolerated at mean of 1.6 days (1-12 days), solids 3.1 days (1-32 days). Mean return of flatus was 1.8 days (1-9 days), first bowel movement 2.9 days (0-13 days). Median length of stay was 4 days (2-43 days). There were no mortalities. Overall morbidity rate was 16.3% (22 patients), with infectious complications being most common or 27% (wound infections, UTIs, pelvic abscesses). There were two anastomotic leaks and two incisional hernias (1.5%).
Conclusion: Laparoscopic colon resection for diverticulits is safe and feasible. A low conversion rate, even in complicated cases argues against the need for routine hand-assisted laparoscopic colectomy. When conversion is needed, it can be in the form of hand-assisted laparoscopy rather than full conversion, thus preserving maximally the benefits of the laparoscopic approach.
Program Number: P102