Mac. Caballero et al., Acute diverticulitis and diverticular disease of the colon: a safe indication for laparoscopic surgery, REV ESP E D, 92(11), 2000, pp. 722-725
AIM: we analyzed our experience with a laparoscopic method for the treatmen
t of acute diverticular disease,
METHODS: between January 1994 and October 1999 a group of 52 patients who f
ulfilled the criteria for symptomatic diverticular disease in the descendin
g and sigmoid colon underwent laparoscopy with resection of an average of 4
0 cm of the bowel. Intraabdominal mechanical anastomosis completed the proc
edure.
RESULTS: the use of ultrasonic scissors made the laparoscopic technique eas
ier and shortened operative time. Operative morbidity was 15%. Two patients
with acute diverticulitis and associated sepsis were reconverted to open s
urgery, and 4 patients presented postoperative rectal bleeding which ceased
spontaneously. No long-term complications were found except in 1 patient w
ho developed an incisional hernia through an entry port. Oral intake began
between the second and third day. Postoperative hospitalization was 3-8 day
s (mean: 5.5 days) and mean operative time was 130 min (range: 70-240 min).
CONCLUSIONS: despite the steep learning curve for this type of surgery, the
good morbidity and mortality rates with the laparoscopic method, especiall
y with high-risk groups of patients (age > 65 years, high blood pressure, e
tc.) suggest that this surgical option can be used efficiently and safely,
and that it achieves better results than with open surgery. However, we fee
l that the treatment of patients with acute complications of diverticular c
olon disease requires extensive experience with laparoscopic colorectal sur
gery.