Acute diverticulitis and diverticular disease of the colon: a safe indication for laparoscopic surgery

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.