Laparoscopic resection of sigmoid diverticulitis - Results of a multicenter study

Background: In the large bowel, resection of the sigmoid colon is the most commonly performed laparoscopic intervention because large bowel lesions of ten are located in this part of the bowel and the procedure technically is the most favorable one. A number of publications involving case series or t he results of highly experienced individual surgeons already have confirmed the feasibility of laparoscopic resection in cases of diverticulitis. The aim of the present prospective multicentric investigation was to check the results obtained by a large number of surgeons performing laparoscopic rese ction of the sigmoid colon for diverticulitis in various stages of severity . Results: Between January 8, 1995 and January 1, 1998, the Laparoscopic Colo rectal Surgery Study Group recruited 1,118 patients to the prospective mult icenter study. Diverticulitis of the sigmoid colon, which accounted for 304 cases, was the most common indication for laparoscopic intervention. In mo st of these patients undergoing laparoscopic surgery (81.9%), the diverticu litis manifested as acute phlegmonous peridiverticulitis, recurrent attacks of inflammation, or stenosis. Complicated forms of diverticulitis in Hinch ey stages I to IV and late complications of chronic diverticular disease wi th fistula formation and bleeding accounted for only 18.1% of the cases. Fo r the overall group, the conversion rate was 7.2%. Patients with less sever e diverticulitis (i.e., those presenting with peridiverticulitis, stenosis, or recurrent attacks of inflammation) had a conversion rate of 4.8% and th e rate for complicated cases was 18.2%. Regarding laparoscopically complete d interventions, 3 of 282 patients died (1.1%). In the group of patients wi th peridiverticulitis, stenosis, or recurrent attacks of inflammation the o verall complication rate was 14.8%. The group with perforated diverticuliti s in Hinchey stages I to IV or those with fistula and bleeding, the corresp onding rate was 28.9%, and after conversion it was 31.8%. Conclusions: Laparoscopic colorectal interventions in sigmoid diverticuliti s are, for the most part, carried out as elective procedures for peridivert iculitis, stenosis, or recurrent attacks of inflammation. The conversion, c omplication, and mortality rates associated with these interventions are ac ceptable. Laparoscopic procedures in Hinchey stages I to IV sigmoid diverti culitis and in the presence of fistula and bleeding are more likely to be a ssociated with complications, and should be carried out only by highly expe rienced laparoscopic surgeons.