Intracorporeal vs laparoscopic-assisted resection for uncomplicated diverticulitis of the sigmoid

Background: Minimally invasive surgery for uncomplicated diverticulitis of the sigmoid (UDS) may be performed either as an intracorporeal procedure (L ICR) or as laparoscopically assisted colon resection (LACR). Methods: Prospectively collected data of 40 selected patients who had under gone LICR for UDS between 1992 and 1994 were compared retrospectively with those of 34 diagnosis-matched LACR controls operated on at the same hospita l between 1995 and 1996 to assess the short-term outcome. Results: There were no mortalities. LICR and LACR patients were well matche d for age, gender, weight, American Society of Anesthesiologists (ASA) grad e, duration of symptoms, and number of previous admissions. There were no s ignificant differences in conversions (one vs three), mobilization of splen ic flexure (11:29 vs 9:25), anastomotic distance from anal verge (12 vs 13 cm), estimated blood loss (270 vs 285 ml), passage of flatus (3.1 vs 3.8 da ys), operating room (OR) costs ($3,040 vs $2,820), and total hospital costs ($9,250 vs $10,050) in LICR and LACR patients, respectively. Suprapubic sk in-incision length (36 vs 60 mm, p << 0.01), size of circular stapler 28:31 mm (1:39 vs 6:28, p = 0.03), specimen length (21 vs 11 cm, p << 0.01), com plication rates (6 vs 5, p = 0.02), OR time (180 vs 244 min, p < 0.001), re sumption of oral solid food intake (3.2 vs 5.8 days, p < 0.001), hospital s tay (4.6 vs 9.9 days, p < 0.001), and ward costs ($2,360 vs $4,950, p < 0.0 01) were significantly different in LICR and LACR patients, respectively. Conclusion: The immediately recognizable advantages of LICR over LACR surmi sed from this study need further evaluation in a prospective randomized set ting. LICR remains a procedure of considerable technical complexity requiri ng high surgical skills.