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.

Abstract

RezumatLigaturarea arterială în timpul sigmoidectomiei laparoscopice de elecţie pentru boală diverticulară poate afecta funcţia genitourinară, lezând plexul hipogastric superior, şi poate diminua perfuzia arterială la nivelul bontului colonic distal. Ligaturarea arterei mezenterice inferioare distal de artera colică stângă sau prezervarea completă a arterei mezenterice inferioare pot fi comparate prin urmare din perspectiva prezervării fibrelor simpatice descendente cu traiect de-a lungul aortei şi către rect, rezultând în funcţii genito-urinare postoperatorii diferite. În perioada ianuarie 2015-martie 2016, 66 de pacienţi au fost supuşi sigmoidectomiei laparoscopice de elecţie pentru boală diverticulară, în cadrul a 2 spitale participante la studiu. Într-unul dintre centre, 35 de pacienţi au fost supuşi sigmoidectomiei laparoscopice cu ligaturarea arterei mezenterice inferioare distal de artera colică stângă (ligaturare joasă). În celălalt centru, 31 de pacienţi au fost operaţi utilizând aceeaşi procedură, de această dată cu prezervarea arterei mezenterice inferioare. Nu au existat diferenţe între cele 2 grupuri în ceea ce priveşte complicaţiile majore apărute, primul scaun postoperator sau durata spitalizării. Durata operaţiei a fost semnificativ mai scurtă în grupul de ligaturare joasă comparativ cu

Long‐term urogenital assessment after elective laparoscopic sigmoid resection for diverticulitis: a comparison between central and peripheral vascular resection

“…Furthermore, a recent prospective study compared the impact of the level of arterial ligation on urogenital function in patients undergoing sigmoid resection for diverticular disease; it reported no difference between the two groups 1 and 9 months' postoperatively [12]. These findings are in line with our long-term assessment, but are influenced by a short postoperative follow-up and a small number of patients (66) compared with our population of more than 300 patients.…”

“…To date, the relationship between the type of vascular approach and long‐term urogenital functional outcomes has not been analysed. In the short term (nine postoperative months), only a recent study, by Mari et al, showed no impact of the level of IMA ligation on urogenital outcome in patients undergoing sigmoid resection for diverticular disease [12]. The aim of this study was to evaluate whether central ligation of the IMA (IMA‐resected group) compared with peripheral dissection (IMA‐preserved group) during sigmoid resection for diverticulitis could impair urinary and sexual function in the long‐term.…”

Predictive model estimating the decrease of postoperative gastrointestinal quality of life index (GIQLI) in patients after elective laparoscopic sigmoid resection for diverticular disease

“…The available studies concerning preservation or resection of the IMA in diverticular disease showed contradictory results. While Masoni et al and Dobrowolski et al reported a lower incidence of defecation disorders, fecal incontinence, and a greater QoL score in patients undergoing to IMA-preserved resection, Mari et al demonstrated no differences between these different vascular approaches at 1 and 9 months after surgery [ 25 – 27 ]. Finally, our study, with a mean follow-up time of 90.4 ± 33.65 months, adds important evidence to the literature that the type of IMA ligation (central vs peripheral) does not represent a predictive estimator of the GIQLI.…”

Robotic natural-orifice IntraCorporeal anastomosis with Extraction (NICE procedure) for complicated diverticulitis

“…The line of dissection is straightforward, and it yields a less bulky specimen which is beneficial for transrectal extraction. This approach also preserves the inferior and superior mesenteric artery and protect against inadvertent damage of the underlying autonomic nerves and ureter and is associated with less sexual, urinary and bladder dysfunction [ 21 , 22 ]. However, this technique requires more advanced minimally invasive skills to dissect through thick, bulky and chalky mesentery which often bleeds [ 21 , 22 ].…”

“…This approach also preserves the inferior and superior mesenteric artery and protect against inadvertent damage of the underlying autonomic nerves and ureter and is associated with less sexual, urinary and bladder dysfunction [ 21 , 22 ]. However, this technique requires more advanced minimally invasive skills to dissect through thick, bulky and chalky mesentery which often bleeds [ 21 , 22 ]. Therefore, a third critical factor is the coordinated use of the vessel sealer in concert with the fenestrated bipolar to divide the tissue and control cumbersome mesentery bleeding.…”