Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Laparoscopic elective treatment of diverticular disease

A comparison between laparoscopic-assisted and resection-facilitated techniques

  • 44 Accesses

  • 21 Citations

Abstract

Background: Because of the presence of significant inflammatory reaction, elective surgical laparoscopic-assisted treatment of complicated diverticular disease can be difficult, leading to a high conversion and complication rate. Laparoscopic alternatives to this assisted approach consist of the hand-assisted method and the more conventional facilitated laparoscopic sigmoid resection. Facilitated laparoscopic sigmoid resection implies laparoscopic mobilization of the sigmoid as much as possible and splenic flexure when called for. Through a Pfannenstiel incision, the difficult steps of the operation—such as the dissection of the inflammatory process and taking down the fistula, but also resection and manual anastomosis—can be performed. In this study, we compare the operating time, conversion rate, complications, and costs of both assisted and resection-facilitated techniques.

Methods: We compared two consecutive series of 35 patients with diverticular disease who underwent a sigmoid resection by laparoscopy. Both groups were comparable in terms of age, gender, and kind of complicated diverticular disease.

Results: The operating time, conversion rate, and costs were all less in the laparoscopic-facilitated group. The fact that there were no conversions in this group is the most important finding of this study. Not only was it possible to convert from the assisted laparoscopic approach to laparotomy (five patients of 35), it was also possible to convert from the assisted to the facilitated form (seven of 35 patients).

Conclusions: Laparoscopic-facilitated sigmoid resection is a feasible intervention for all forms of complicated diverticular disease and yields marked reductions in operating time, conversion rate, and operative and general costs.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Bemelman WA, Ringers J, et al. (1996) Laparoscopic assisted colectomy with the dexterity pneumo sleeve. Dis Colon Rectum 39 (Suppl): S59-S61

  2. 2.

    Bergamaschi R (1997) Uncomplicated diverticulitis of the sigmoid: old challenges. Scand J Gastroenterol 32: 1187–1189

  3. 3.

    Berthou JC, Charbonneau P (1997) Results of laparoscopic treatment of diverticular sigmoiditis: apropos of 85 cases. Chirurgie 122: 424–429

  4. 4.

    Bruce CJ, Coller JA, et al. (1992) Laparoscopic resection of diverticular disease. Dis Colon Rectum 35: 64–68

  5. 5.

    Bruce CJ, Coller JA, et al. (1996) Laparoscopic resection for diverticular disease. Dis Colon Rectum 39 (Suppl): S1-S6

  6. 6.

    Cady J, Godfrey J, Sibaud O (1995) Laparoscopic resection anastomosis in diverticular sigmoiditis and its complications: apropos of 65 cases. Chirurgie 10: 605–610

  7. 7.

    Cuesta MA, Borgstein PJ, Paul MA, de Jong D (1992) Surgery of the distal colon assisted by laparoscopy. Video Rev Surg 9: 10–21

  8. 8.

    Eijsbouts QAJ, Cuesta MA, de Brauw LM, Sietses C (1997) Elective laparoscopic-assisted sigmoid resection for diverticular disease. Surg Endosc 11: 750–753 DOI: 10.1007/s004649900442

  9. 9.

    Franklin ME Jr, Dorman JP, et al. (1997) Is laparoscopic surgery applicable to complicated colonic diverticular disease? Surg Endosc 11: 1021–1025 DOI: 10.1007/s004649900516

  10. 10.

    Hewett PJ, Stitz R (1995) The treatment of internal fistulae that complicate diverticular disease of the sigmoid colon by laparoscopically assisted colectomy. Surg Endosc 9: 411–413

  11. 11.

    Hinchey EJ, Schaal PG, Richards GK (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12: 85–109

  12. 12.

    Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1: 144–150

  13. 13.

    Junghans TB, Bohm (1997) Progress in laparoscopic sigmoid resection in elective surgical therapy of sigmoid diverticulitis. Langenbecks Arch Chir 382: 266–270 DOI: 10.1007/s004230050064

  14. 14.

    Kohler L, Rixen D, et al. (1998) Laparoscopic colorectal resection for diverticulitis. Int J Colorectal Dis 13: 43–47 DOI: 10.1007/S003840050130

  15. 15.

    Liberman MA, Phillips EH, et al. (1996) Laparoscopic colectomy vs traditional colectomy for diverticulitis: outcome and costs. Surg Endosc 10: 15–18 DOI: 10.1007/s004649910002

  16. 16.

    Mooney MJ, Elliot L, et al. (1998) Hand assisted laparoscopic sigmoidectomy for diverticulitis. Dis Colon Rectum 41: 630–635

  17. 17.

    Phillips EH, Rosenthal RJ (19xx) Nomenclature in laparoscopic colon surgery. In: Phillips EH, Rosenthal RJ (eds) Operative strategies in laparoscopic surgery. Springer Verlag, New York, pp 215–218

  18. 18.

    Puente I, Sosa JL, Utpal Desai BS, Sleeman D, Hartmann R (1994) Laparoscopic treatment of colovesical fistulas: technique and reports of two cases. Surg Laparosc Endosc 4: 157–160

  19. 19.

    Schiedeck TH, Schwandner O, et al. (1998) Laparoscopic sigmoid resection in diverticulitis. Chirurg 69: 846–853 DOI: 10.1007/S001040050499

  20. 20.

    Senagore AJ, Luchtfeld M (1994) Initial experience with lighted ureteral catheters during laparoscopic colectomy. Surg Laparosc Endosc 4: 399–403

  21. 21.

    Sher ME, Agachan F, et al. (1997) Laparoscopic surgery for diverticulitis. Surg Endosc 11: 264–267 DOI: 10.1007/s004649900340

  22. 22.

    Stabiele BE, Puccio E, van Sonneneberg E, Neff CC (1990) Percutaneous drainage of diverticular abscesses. Am J Surg 159: 99–105

  23. 23.

    Standard Task Force of the American Society of Colon and Rectal Surgeons (1995) Practice parameters for sigmoid diverticulitis—supporting documentation. Dis Colon Rectum 38: 126–132

  24. 24.

    Stevenson AR, Stitz RW (1998) Laparoscopic assisted anterior resection for diverticular disease: follow-up of 100 consecutive patients. Ann Surg 227: 335–342

Download references

Author information

Correspondence to M. A. Cuesta.

Additional information

Online publication: 10 May 2000

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Eijsbouts, Q.A.J., de Haan, J., Berends, F. et al. Laparoscopic elective treatment of diverticular disease. Surg Endosc 14, 726–730 (2000). https://doi.org/10.1007/s004640000111

Download citation

Key words

  • Elective procedure
  • Diverticular disease
  • Laparoscopic colonic resection