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International Journal of Colorectal Disease

, Volume 33, Issue 7, pp 887–894 | Cite as

Peripheral vs pedicle division in laparoscopic resection of sigmoid diverticulitis: a 10-year experience

  • Alberto Posabella
  • Niccolò Rotigliano
  • Athanasios Tampakis
  • Markus von Flüe
  • Ida Füglistaler
Original Article

Abstract

Purpose

Laparoscopic rectosigmoid resection is the standard surgical treatment for recurrent sigmoid diverticulitis. However, speaking of mesenterium division, no unique standard procedure is actually provided. Surgeons can perform it at the level of either the sigmoid vessels or the inferior mesenteric vessels. The objective of this study was to compare intra- and postoperative complications of both techniques.

Methods

From a prospective collected database of patients that underwent elective laparoscopic sigmoid resection between January 2004 and December 2014, a retrospective analysis according to the selected operative technique was performed.

Results

A total of 1016 patients were operated, and a pedicle division of the mesenteric vessels was performed in 280 patients (central group 27.6%) while a peripheral division was performed in 736 patients (peripheral group 72.4%). Comparison of these two groups demonstrated no statistically significant difference regarding age or stage of disease. Thirteen patients (1.3%) developed anastomotic leak; among them, nine belonged to the peripheral group (1.2 vs 1.4% p = 0.794). Twenty-four patients (2.4%) developed postoperative rectal bleeding but only in nine cases was a bleeding of the anastomosis confirmed using endoscopy (seven peripheral group vs two central group, 0.95 vs 0.7% p = 0.712). Moreover, postoperative morbidity did not significantly differ between the two groups. A very low mortality rate was observed, with 2 deaths (both in the peripheral group).

Conclusions

Ligation of inferior mesenteric vessels does not seem to affect anastomotic healing; both surgical techniques presented similar incidence of anastomotic bleeding. In this analysis, we could not identify any significant difference in overall morbidity and mortality.

Keywords

Laparoscopic rectosigmoid resection Pedicle and peripheral division mesenteric vessels Anastomotic leak Anastomosis bleeding 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no potential conflicts of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alberto Posabella
    • 1
  • Niccolò Rotigliano
    • 1
  • Athanasios Tampakis
    • 1
  • Markus von Flüe
    • 1
  • Ida Füglistaler
    • 1
  1. 1.Department of Visceral SurgerySt. Clara HospitalBaselSwitzerland

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