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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

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References

  1. Dwivedi A, Chahin F, Agrawal S et al. (2002) Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease. Dis Col Rectum 45(10):1309–14

  2. Schwenk W, Haase O, Neudecker J et al. (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev (3):CD003145

  3. Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW (2003) Results of a standardized technique and postoperative careplan for laparoscopic sigmoid colectomy. Dis Col Rectum 46:503–509

    Article  Google Scholar 

  4. Faucheron JL (2005) Pelvic anatomy for colorectal surgeons. Acta Chir Belg 105(5):471–474

    Article  PubMed  CAS  Google Scholar 

  5. Forgione A, Leroy J, Cahill RA, Bailey C, Simone M, Mutter D, Marescaux J (2009) Prospective evaluation of functional outcome after laparoscopic sigmoid colectomy. Ann Surg 249(2):218–224

    Article  PubMed  Google Scholar 

  6. Schwandner O, Farke S, Fischer F, Eckmann C, Schiedeck TH, Bruch HP (2004) Laparoscopic colectomy for recurrent and complicated diverticulitis: a prospective study of 396 patients. Langenbeck's Arch Surg 389(2):97–103

    Article  CAS  Google Scholar 

  7. Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD, Rafferty JF (2014) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 57(3):284–294

    Article  PubMed  Google Scholar 

  8. Thaler K, Baig MK, Berho M, Weiss EG, Nogueras JJ, Arnaud JP, Wexner SD, Bergamaschi R (2003) Determinants of recurrence after sigmoid resection for uncomplicated diverticulitis. Dis Colon Rectum 46(3):385–388

    Article  PubMed  Google Scholar 

  9. Cirocchi R, Trastulli S, Farinella E, Desiderio J, Listorti C, Parisi A, Noya G, Boselli C (2012) Is inferior mesenteric artery ligation during sigmoid colectomy for diverticular disease associated with increased anastomotic leakage? A metaanalysis of randomized and non-randomized clinical trials. Color Dis 14:e521–e529

    Article  CAS  Google Scholar 

  10. Stocchi L (2010) Current indications and role of surgery in the management of sigmoid diverticulitis. World J Gastroenterol 16(7):804–817

    PubMed  PubMed Central  Google Scholar 

  11. Rafferty J, Shellito P, Hyman NH, Buie WD, Standards Committee of American Society of Colon and Rectal Surgeons (2006) Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 49(7):939–944

    Article  PubMed  Google Scholar 

  12. Sohn M, Schlitt HJ, Hornung M et al (2017) Preservation of the superior rectal artery: influence of surgical technique anastomotic healing and postoperative morbidity in laparoscopic sigmoidectomy for diverticular disease. Int J Colorectal Dis 32(7):955–960. https://doi.org/10.1007/s00384-017-2792-x

    Article  PubMed  Google Scholar 

  13. Bhakta A, Tafen M, Glotzer O, Canete J, Chismark AD, Valerian BT, Stain SC, Lee EC (2016 Apr) Laparoscopic sigmoid colectomy for complicated diverticulitis is safe: review of 576 consecutive colectomies. Surg Endosc 30(4):1629–1634

    Article  PubMed  Google Scholar 

  14. Billeter AT, Polk HC Jr, Hohmann SF, Qadan M, Fry DE, Jorden JR, McCafferty MH, Galandiuk S (2012) Mortality after elective colon resection: the search for outcomes that define quality in surgical practice. J Am Coll Surg 214(4):436–443

    Article  PubMed  Google Scholar 

  15. Thornton FJ, Barbul A (1997) Healing in the gastrointestinal tract. Surg Clin North Am 77:549–573

    Article  PubMed  CAS  Google Scholar 

  16. Schrock TR, Deveney CW, Dunphy JE (1973) Factors contributing to leakage of colonic anastomoses. Ann Surg 177:513–518

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Rose J, Schneider C, Yildirim C, Geers P, Scheidbach H, Köckerling F (2004) Complications in laparoscopic colorectal surgery: results of a multicentre trial. Tech Coloproctol 8(Suppl 1):s25–s28

    Article  PubMed  Google Scholar 

  18. Morino M, Parini U, Giraudo G (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237:335–342

    PubMed  PubMed Central  Google Scholar 

  19. McDermott FD, Heeney A, Kelly M et al (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102(5):462–479

    Article  PubMed  CAS  Google Scholar 

  20. Dworkin MJ, Allen-Mersh TG (1996) Effect of inferior mesenteric artery ligation on blood flow in the marginal artery-dependent sigmoid colon. J Am Coll Surg 183(4):357–360

    PubMed  CAS  Google Scholar 

  21. Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, Troidl H (1995 Feb) Gastrointestinal quality of life index: development, validation and application of a new instrument. Br J Surg 82(2):216–222

    Article  PubMed  CAS  Google Scholar 

  22. Perez RO, Sousa A Jr, Bresciani C et al (2007) Endoscopic management of postoperative stapled colorectal anastomosis hemorrhage. Tech Coloproctol 11:64–66

    Article  PubMed  CAS  Google Scholar 

  23. Jex RK, van Heerden JA, Wolff BG et al (1987) Gastrointestinal anastomoses. Factors affecting early complications. Ann Surg 206:138–141

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Killingback M (1990) Diverticulitis of the colon. In: Fazio VW (ed) Current therapy in colon and rectal surgery. Decker, Philadelphia, pp 222–231

    Google Scholar 

  25. Silver A, Bendick P, Wasvary H (2005) Safety and efficacy of supraselective angioembolization in control of lower gastrointestinal hemorrhage. Am J Surg 189:361–366

    Article  PubMed  Google Scholar 

  26. Martínez-Serrano MA, Parés D, Pera M, Pascual M, Courtier R, Egea MJG, Grande L (2009) Management of lower gastrointestinal bleeding after colorectal resection and stapled anastomosis. Tech Coloproctol 13:49–53

    Article  PubMed  Google Scholar 

  27. Tocchi A, Mazzoni G, Fornasari V, Miccini M, Daddi G, Tagliacozzo S (2001 Aug) Preservation of the inferior mesenteric artery in colorectal resection for complicated diverticular disease. Am J Surg 182(2):162–167

    Article  PubMed  CAS  Google Scholar 

  28. Pignata G (2006) Laparoscopic treatment for acute diverticular disease. Acta Chir Iugosl 53(3):19–22

    Article  PubMed  Google Scholar 

  29. Lehmann RK, Brounts LR, Johnson EK, Rizzo JA, Steele SR (2011) Does sacrifice of the inferior mesenteric artery or superior rectal artery affect anastomotic leak following sigmoidectomy for diverticulitis? A retrospective review. Am J Surg 201(5):623–627. https://doi.org/10.1016/j.amjsurg.2011.01.011

    Article  PubMed  Google Scholar 

  30. Trencheva K, Morrissey KP, Wells M, Mancuso CA, Lee SW, Sonoda T, Michelassi F, Charlson ME, Milsom JW (2013) Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg 257(1):108–113. https://doi.org/10.1097/SLA.0b013e318262a6cd

    Article  PubMed  Google Scholar 

  31. Bergamaschi R, Arnaud JP (1998) Anastomosis level and specimen length in surgery for uncomplicated diverticulitis of the sigmoid. Surg Endosc 12(9):1149–1151

    Article  PubMed  CAS  Google Scholar 

  32. Borchert DH, Schachtebeck M, Schoepe J, Federlein M, Bunse J, Gellert K, Burghardt J (2015) Observational study on preservation of the superior rectal artery in sigmoid resection for diverticular disease. Int J Surg 21:45–50. https://doi.org/10.1016/j.ijsu.2015.07.011

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Visceral Surgery, St. Clara Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland

    Alberto Posabella, Niccolò Rotigliano, Athanasios Tampakis, Markus von Flüe & Ida Füglistaler

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  1. Alberto Posabella
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  2. Niccolò Rotigliano
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  3. Athanasios Tampakis
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  4. Markus von Flüe
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Correspondence to Alberto Posabella.

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Posabella, A., Rotigliano, N., Tampakis, A. et al. Peripheral vs pedicle division in laparoscopic resection of sigmoid diverticulitis: a 10-year experience. Int J Colorectal Dis 33, 887–894 (2018). https://doi.org/10.1007/s00384-018-3080-0

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  • DOI: https://doi.org/10.1007/s00384-018-3080-0

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