Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of laparoscopic-assisted sigmoid colectomy for the treatment of diverticuli tis. METHODS: The Norfolk Surgical Group Laparoscopic Surgery Registry iden tified all patients undergoing laparoscopic colon and rectal surgery. Retro spective chart review was performed for all patients undergoing elective si gmoid resection for a final diagnosis of diverticulitis and minimum follow- up of 12 months. Demographic data, indications for surgery, operative data, conversion rate, reason for conversion, complications, postoperative cours e (days to flatus and regular diet), and length of stay were identified. A telephone survey determined the incidence of recurrent diverticulitis. Stat istical analysis was performed to evaluate the frequency of conversion over time, to determine risk factors for conversion, and to compare the laparos copic-assisted and conversion groups with regard to postoperative days to f latus, regular diet, and discharge. RESULTS: From June 1992 to September 19 97, elective laparoscopic-assisted sigmoid colectomy was attempted in 69 pa tients. Uncomplicated recurrent diverticulitis was the most common indicati on for surgery, occurring in 51 of 69 patients (75 percent). No deaths occu rred. Complications were identified in seven patients (10.1 percent) includ ing one wound infection and one incarcerated port-site hernia with small bo wel obstruction. There mere no anastomotic leaks or major septic complicati ons. Conversion to laparotomy occurred in 18 of 69 patients (26 percent). U ncomplicated, recurrent diverticulitis was associated with conversion in 7 of 51 patients (14 percent), whereas complicated diverticulitis required co nversion in 11 of 18 patients (61 percent). Logistic regression identified fistula and abscess as predictors of conversion (P = 0.0009). Comparison of the laparoscopic-assisted sigmoid colectomy group with the conversion grou p revealed that postoperative days to regular diet were 3.5 and 5.2 (P = 0. 0004), respectively, and lengths of stay were 4.2 and 6.4 days (P < 0.0001) , respectively, No difference was noted with regard to operative time or po stoperative complications. Median follow-up was 48 (range, 13-76) months, a nd a single recurrence of diverticulitis has been identified. CONCLUSIONS: Laparoscopic-assisted sigmoid colectomy for diverticulitis can be safely pe rformed. Conversion appears to be associated with complicated diverticuliti s (fistula or abscess), which may be better approached by laparotomy. Short -term follow-up indicates that recurrence is rare and suggests that laparos copic-assisted sigmoid colectomy achieves adequate resection. Laparoscopic- assisted sigmoid colectomy offers benefits of decreased ileus and length of sta) and may represent the procedure of choice for elective resection for uncomplicated sigmoid diverticulitis.