Summary Background Diverticular disease appears to be one of the most common conditions in the Western world. The standard approach in treatment of diverticular disease is a laparoscopic resection, usually after an inflammation-free time of 4 to 6 weeks. The aim of this study was to evaluate the timing of operation. Materials and methods A total of 61 patients underwent left-sided colonic resection because of diverticular disease between January 2017 and February 2020. Because of complicated diverticulitis (CDD stage 2a or 2b) 37 patients were treated either early within 7 days after first symptoms (group A: n = 17) or delayed about 6 weeks after the first contact and conservative therapy (group B: n = 20). Results Overall mortality was 0%. The average operation time was shorter in the early elective group (group A: 140.4 min vs. group B: 151.2 min; p = 0.29). The hospital stay (group A: 9.9 days vs. group B: 16.9 days) and the postoperative stay (group A: 4.8 days vs. group B: 8.1 days) were significantly longer in group B (p = 0.01). We observed—although not reliable due to the low number of patients—more postoperative complications in the delayed group (group A: 5.9% vs. group B: 15.0%; p = 0.61). Conclusion The data in this study confirm the early operation as safe and efficient due to lower costs. We can recommend an early approach in selected cases with the first episode of a complicated diverticulitis.

Introduction Endometriosis is associated with a high number of chronic pelvic pain and reduced quality of life. Colorectal resections in case of bowel involvement of endometriosis are associated with an unneglectable morbidity in young and healthy patients. There is no linear correlation established between the degree of symptoms and stage of endometriosis. The aim of this study was to correlate the histological findings to preoperative pain scores in colorectal resected patients with endometriosis. Methods Twenty-five patients who underwent laparoscopic colorectal resection for endometriosis between 2014 and 2019 were included in this retrospective study. Pain level was assessed preoperatively and postoperatively via phone call in May 2020. Histopathology was correlated to preoperative symptoms and postoperative outcome. Results Average follow-up time was 38.68 months (± 19.92). Preoperative VAS-score was 8.32 (± 1.70). We observed a significant reduction of pain level in all patients after surgery (p ≤ 0.005). Pain levels were equal regarding the presence of satellite spots and various degrees of infiltration depth. The resection margins were clear in all patients. Postoperative complications occurred in 6 cases (24%) and anastomotic leakage was observed in 3 patients (12%). Average VAS-score at time of follow-up was 1.70 (± 2.54). Conclusion Our data demonstrate that adequate colorectal resection leads to reduction of pain and an increase of quality of life irrespective of histopathological findings. An experienced team is necessary to improve intraoperative outcome and to reduce postoperative morbidity in case of complication.

Unsere Erfahrungen zeigen, daβ sich die laparoskopische Appendektomie trotz kritischer Meinungen sehr gut als Regeleingriff in einer Ausbildungsklinik eignet. Vorteile ergeben sich aus der geringeren postoperativen Liegezeit und aus den guten kosmetischen Ergebnisse, insbesondere bei adipösen Patienten. Allerdings ist auch die laparoskopische Appendektomie, wie jeder invasive Eingriff, nicht frei von Komplikationen. Dennoch hat sie im Vergleich zur offenen Wurmfortsatzentfemung gute Ergebnisse vorzuweisen. Ungleich günstiger schneidet sie in jenen Bereichen ab, die die Wertigkeit der herkömmlichen Appendektomie bis heute belasten, nämlich bei den septischen Komplikationen. Gute Ergebnisse werden insbesondere in der stark infektgefährdeten Risikogruppe II mit den fortgeschrittenen Appendizitisbefunden erreicht. Gerade dort werden wir nach herkömmlicher Appendektomie eine über Gebühr hohe septische Komplikationsrate einkalkulieren müssen. Da vor alien Dingen Patienten mit fortgeschrittenen Appendizitisbefunden maximal von der laparoskopischen Vorgehensweise profitieren, sollte die Indikation zur Appendektomie weiterhin wie bei der offenen Operation eng gestellt werden. Zur weiteren Minimierung der jetzt schon sehr niedrigen septischen Komplikationsrate empfehlen wir darüber hinaus die Bauchhöhlendrainage, ferner die Verabreichung von Antibiotika in der Risikogruppe II und zur Vermeidung der Zäkaldistension in der Risikogruppe I die konsequente appendixnahe Skelettierung. Zugangsbedingte Komplikationen sind hingegen bei sachgemäβer Vorgehensweise von untergeordneter Relevanz und lassen sich normalerweise leicht beherrschen.

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