Laparoscopic sigmoid resection for diverticular disease

It is still difficult to determine the exact indication for a laparoscopic sigmoid resection for diverticular disease. Frequently, the severity of div erticulitis is not sufficiently defined. For this reason a modification of the Hinchey classification is proposed to which a stage II b for fistula fo rmation and a differentiation between acute and chronic disease have been a dded. Another problem is the lack of criteria which define a "laparoscopic" resection. A sigmoid resection should be called "laparoscopic" if the mobi lization of the sigmoid colon, the transsection of the mesenteric vein and artery and the mesentery itself and the distal transsection of the bowel ar e done laparoscopically. The resection of the bowel and the introduction of the anvil of the stapler device can be done extraabdominally, however, the anastomosis again should be performed laparoscopi- cally. A so defined sig moid rejection can be done in the chronic stage I. In the chronic stage II a there will be significant problems due to adhesion formation, and in the acute stages II a and II b as well as in the chronic stage II b a laparosco pic resection should not be attempted.