Functional Results Following Elective Laparoscopic Sigmoidectomy After CT-Proven Diagnosis of Acute Diverticulitis Evaluation of 43 Patients and Review of the Literature

Abstract

We performed a prospective study to analyze the functional results following elective laparoscopic sigmoidectomy for computed tomography (CT)-proven diagnosis of acute diverticulitis and review the literature. Forty-three of 45 available patients (96%) who had laparoscopic sigmoidectomy for CT-proven acute diverticulitis answered, after a mean time of 40 months, a questionnaire exploring new abdominal symptoms, bowel function, and the patient's own judgement of the surgical outcome. Surgical technique aimed at removing all the sigmoid by taking down the splenic flexure and do a colorectal anastomosis. Four patients (9%) complained of new abdominal pain. Bowel function was reported as better for 24 patients (56%), unchanged for 16 patients (37%), and worse for 3 (7%). Twenty patients (47%) considered their final result as excellent to good, 17 patients (40%) as satisfying, and 6 patients (13%) as mediocre. Male gender, absence of preoperative history compatible with an irritable bowel syndrome, length of resected sigmoid and residual acute inflammation on histology are statistically predictive of a better postoperative degree of satisfaction. After elective laparoscopic sigmoidectomy for CT-proven diverticulitis, a great majority of patients are very satisfied with their postoperative general comfort.

Genito-Urinary Function and Quality of Life after Elective Totally Laparoscopic Sigmoidectomy after at Least One Episode of Complicated Diverticular Disease According to Two Different Vascular Approaches: the IMA Low Ligation or the IMA Preservation.

“…The 0% converison rate and the avoidance of stoma creation suggest how elective laparoscopic sigmoidectomy is a feasible and safe procedure in experienced hands (16). 2 cases of anastomotic fistula in the IP group and 1 in the LL group happened after anastomotic bleeding.…”

Value of CT for Acute Left-Colonic Diverticulitis: The Surgeon’s View

“…The highest postoperative scores correlated with the lowest preoperative ones [22]. Our prospective study on 43 patients had similar results [23]. Unfortunately, there is still no study that has drawn a correlation between the quality of elective surgery (length of proximal resection, mobilization of the splenic flexure, vascular approach) and the postoperative risk of recurrence and quality of life.…”

“…We know now that colorectal rather than colosigmoid anastomosis is the single predictor of lower recurrence after elective sigmoid resection [20,21]. Moreover, only two prospective studies evaluated functional outcome after elective laparoscopic sigmoidectomy [22,23]. The first study found significant improvement in quality of life and social functioning in the majority of patients [22].…”

Comparison of long-term quality of life in patients with diverticular disease. Are there any benefits to surgery?

“…Stevenson et al and similar Ambrosetti et al in their studies regarding laparoscopic resection for diverticular disease advocate this surgery to achieve patient satisfaction with cosmetic and functional results [27,28] [31]. These authors attribute perstistent abdominal discomfort to irritable bowel syndrome, inappropriate indications for surgery, or insufficient length of resected colon.…”

“…In the years 2000-2005 we tended to treat diverticulitis with open surgery, not laparoscopically. The positive effects of surgery have been reported especially after laparoscopy [28,29]. So, it appears that open surgery has an adverse effect and simultaneously has no positive effect in terms of quality of life.…”