Laparoscopic vs open colectomy for sigmoid diverticulitis - A prospective comparative study in the elderly

Background: The aim of this prospective comparative study was to assess the outcome of laparoscopic and open colectomy for sigmoid diverticulitis in p atients aged greater than or equal to 75 years. Methods: From January 1993 to December 1998, all patients 75 years of age a nd older undergoing an elective colectomy for sigmoid diverticulitis were i ncluded in the study. The patients were divided into the following two grou ps: group 1 (n = 22) consisted of patients who underwent a laparoscopic pro cedure; group 2 (n = 24) consisted of patients who underwent an open proced ure. Results: In group 1, there were 12 women and 10 men with a mean age of 77.2 years (range, 75-82); in group 2, there were 14 women and 10 men with a me an age of 78 years (range, 76-84) (p = 0.37). There was no difference betwe en the groups in ASA classification. The operative time was shorter in grou p 2 (136 vs 234 mins). The postoperative period during which parenteral ana lgesics were required (5.4 vs 8.2 days, p = 0.001), postoperative morbidity (18% vs 50%, p = 0.02), postoperative length of hospital stay (13.1 vs 20. 2 days, p = 0.003), and the inpatient rehabilitation (6 vs 15 patients, p = 0.01) were significantly shorter for group 1 than for group 2. There were no perioperative deaths. The conversion rate was 9% in group 1. Conclusion: The data from the present study suggest that laparoscopic colec tomy for sigmoid diverticulitis can be applied safely to older patients wit h fewer complication, less pain, shorter hospital stay, and a more rapid re turn to preoperative activity levels than that seen with open colorectal re section.