Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2016; 8(4): 308-314
Published online Apr 27, 2016. doi: 10.4240/wjgs.v8.i4.308
Laparoscopic approach in complicated diverticular disease
Nicolás A Rotholtz, Alejandro G Canelas, Maximiliano E Bun, Mariano Laporte, Emmanuel E Sadava, Natalia Ferrentino, Sebastián A Guckenheimer
Nicolás A Rotholtz, Alejandro G Canelas, Maximiliano E Bun, Mariano Laporte, Emmanuel E Sadava, Natalia Ferrentino, Sebastián A Guckenheimer, Department of Surgery, Hospital Alemán, Buenos Aires C1118AAT, Argentina
Nicolás A Rotholtz, Alejandro G Canelas, Maximiliano E Bun, Mariano Laporte, Sebastián A Guckenheimer, Colorectal Surgery Division, Hospital Alemán, Buenos Aires C1118AAT, Argentina
Author contributions: Rothotlz NA designed the study; Canelas AG and Laporte M contributed to the conduct of the study; Bun ME performed the statistical analysis; Sadava EE and Ferrentino N collected and analyzed the data; Guckenheimer SA performed the research and drafted the manuscript; all authors read and approved the final version of the paper.
Institutional review board statement: As anonymized administrative and clinical data were used for this study, it was exempt from formal ethics review.
Informed consent statement: As anonymized administrative and clinical data were used for this study, specific written consent was not required to use patient information stored in hospital databases.
Conflict-of-interest statement: The authors declare that there is no conflict of interests regarding the publication of this article.
Data sharing statement: Consent was not obtained but the presented data are anonymized and risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Sebastián A Guckenheimer, Colorectal Surgery Division, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina. guckenheimers@gmail.com
Telephone: +54-11-48277000 Fax: +54-11-48277000
Received: June 25, 2015
Peer-review started: June 28, 2015
First decision: August 16, 2015
Revised: November 27, 2015
Accepted: February 14, 2016
Article in press: February 16, 2016
Published online: April 27, 2016
Abstract

AIM: To analyze the results of laparoscopic colectomy in complicated diverticular disease.

METHODS: This was a retrospective cohort study conducted at an academic teaching hospital. Data were collected from a database established earlier, which comprise of all patients who underwent laparoscopic colectomy for diverticular disease between 2000 and 2013. The series was divided into two groups that were compared: Patients with complicated disease (abscess, perforation, fistula, or stenosis) (G1) and patients undergoing surgery for recurrent diverticulitis (G2). Recurrent diverticulitis was defined as two or more episodes of diverticulitis regardless of patient age. Data regarding patient demographics, comorbidities, prior abdominal operations, history of acute diverticulitis, classification of acute diverticulitis at index admission and intra and postoperative variables were extracted. Univariate analysis was performed in both groups.

RESULTS: Two hundred and sixty patients were included: 28% (72 patients) belonged to G1 and 72% (188 patients) to G2. The mean age was 57 (27-89) years. The average number of episodes of diverticulitis before surgery was 2.1 (r 0-10); 43 patients had no previous inflammatory pathology. There were significant differences between the two groups with respect to conversion rate and hospital stay (G1 18% vs G2 3.2%, P = 0.001; G1: 4.7 d vs G2 3.3 d, P < 0.001). The anastomotic dehiscence rate was 2.3%, with no statistical difference between the groups (G1 2.7% vs G2 2.1%, P = 0.5). There were no differences in demographic data (body mass index, American Society of Anesthesiology and previous abdominal surgery), operative time and intraoperative and postoperative complications between the groups. The mortality rate was 0.38% (1 patient), represented by a death secondary to septic shock in G2.

CONCLUSION: The results support that the laparoscopic approach in any kind of complicated diverticular disease can be performed with low morbidity and acceptable conversion rates when compared with patients undergoing laparoscopic surgery for recurrent diverticulitis.

Keywords: Complicated diverticulitis, Laparoscopy, Recurrent diverticulitis, Sigmoid colectomy, Outcomes

Core tip: Several studies have shown clear benefits of the use of laparoscopic colectomy in diverticular disease. However, this approach is not well defined in patients with complicated disease. In the current study, the results support that laparoscopic surgery can be performed with acceptable results for any indication of diverticular disease.