Laparoscopic Sigmoidectomy for Diverticulitis: a Prospective Study

Elgazwi, Khaled; Baća, I.; L, Grzybowski; Jaacks, Armin

doi:10.4293/108680810x12924466008088

Cited by 24 publications

(3 citation statements)

References 24 publications

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“…Similar to others 36 , we documented one anastomotic leak, but there was no mortality. Larger studies 46,47 have reported anastomotic leak rates of 1.4 to 1.9% and mortality rates of 0.2 to 0.76%. In the study by van de Wall et al 26 , 12% of patients had anastomotic leakage, without any fatalities at 6 months follow up.…”

Section: Discussionmentioning

confidence: 99%

Quality of life in uncomplicated recurrent diverticulitis: surgical vs. conservative treatment

Justin

Uranues

Rabl

et al. 2020

Sci Rep

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elective sigmoid colectomy for recurrent uncomplicated diverticulitis remains controversial and is decided on an individual basis. Eighty patients treated conservatively (44 patients) or by elective surgery (36 patients) for recurrent uncomplicated diverticulitis were contacted and assessed for quality of life. The mean difference in quality of life scores was greater after surgery (overall + 2.14%, laparoscopic resection +4.95%, p = 0.36 and p = 0.11, respectively) as compared to conservative management. Female patients undergoing laparoscopic resection had statistically significantly higher quality of life scores than women treated conservatively (+8.98%; p = 0.049). Twenty-eight of 29 responding patients stated that they were highly satisfied and would have the operation done again. elective sigmoidectomy is a valid treatment option for recurrent uncomplicated diverticulitis in terms of quality of life. Quality of life improved most if surgery was performed laparoscopically, especially in women. Diverticular disease of the colon is a common condition in Western countries 1. While this condition remains clinically silent in the majority of the affected population, 4% to 20% of people develop acute inflammation at least once in their lifetime 2,3. Hospital admissions for diverticular disease, especially in patients younger than 45 years, have been increasing steadily in recent decades 1,4,5. Historically, resection was recommended after two episodes of uncomplicated diverticulitis 6-8 , a policy based on the assumption that patients with recurrent episodes were thought to have a 30 to 60% risk of developing further recurrences, serious complications 6,9 and reduced response to medical treatment 10. More recent data have challenged these findings. While recurrences after medical treatment have been described in 13.3% to 36% 11-14 of patients, only 3% to 5% develop complicated disease as defined by Wasvary et al. 12,13,15. Notably, a large population based study 11 found a significantly higher risk for re-recurrence than that for a first recurrence (29.3% vs. 13.3%, p < 0.001), but without any increase in severity 16. Consequently, prophylactic resection after two episodes to prevent complications in the immunocompetent patient is no longer advised and conservative treatment is considered to be the standard of care in uncomplicated diverticulitis 17-20. Up to 38% of patients report persisting abdominal complaints after conservatively treated diverticulitis 21,22. Recurrent bouts of diverticulitis have been shown to have a negative impact on health related quality of life (HR-QOL) 23,24. Improvements of HR-QOL and alleviation of diverticulitis-associated symptoms therefore remain among the main indications for elective interval resection 18,25. Only one randomized study 26 has prospectively compared HR-QOL after resection with medical treatment in recurrent diverticulitis but none, to our knowledge, has done so in uncomplicated diverticular disease. The aim of this study was to compare HR-QOL in recurrent, uncompli...

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Section: Discussionmentioning

confidence: 99%

Quality of life in uncomplicated recurrent diverticulitis: surgical vs. conservative treatment

Justin

Uranues

Rabl

et al. 2020

Sci Rep

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“…Minimally invasive access to the abdominal cavity (laparoscopy) is the standard approach for various procedures in visceral surgery [1,2], since patients generally experience less postoperative pain, recover faster, and have improved perioperative morbidity and mortality [3][4][5][6]. As such, the laparoscopic approach is increasingly employed for more complex surgeries including oncological procedures [7][8][9][10][11].…”

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confidence: 99%

Optimizing laparoscopic training efficacy by ‘deconstruction into key steps’: a randomized controlled trial with novice medical students

et al. 2022

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Background Simulator training is an effective way of acquiring laparoscopic skills but there remains a need to optimize teaching methods to accelerate learning. We evaluated the effect of the mental exercise ‘deconstruction into key steps’ (DIKS) on the time required to acquire laparoscopic skills. Methods A randomized controlled trial with undergraduate medical students was implemented into a structured curricular laparoscopic training course. The intervention group (IG) was trained using the DIKS approach, while the control group (CG) underwent the standard course. Laparoscopic performance of all participants was video-recorded at baseline (t0), after the first session (t1) and after the second session (t2) nine days later. Two double-blinded raters assessed the videos. The Impact of potential covariates on performance (gender, age, prior laparoscopic experience, self-assessed motivation and self-assessed dexterity) was evaluated with a self-report questionnaire. Results Both the IG (n = 58) and the CG (n = 68) improved their performance after each training session (p < 0.001) but with notable differences between sessions. Whereas the CG significantly improved their performance from t0 –t1 (p < 0.05), DIKS shortened practical exercise time by 58% so that the IG outperformed the CG from t1 -t2, (p < 0.05). High self-assessed motivation and dexterity associated with significantly better performance (p < 0.05). Male participants demonstrated significantly higher overall performance (p < 0.05). Conclusion Mental exercises like DIKS can improve laparoscopic performance and shorten practice times. Given the limited exposure of surgical residents to simulator training, implementation of mental exercises like DIKS is highly recommended. Gender, self-assessed dexterity, and motivation all appreciably influence performance in laparoscopic training.

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“…The feasibility issue was answered by studies such as the one by El Zarrok Elgazwi et al [2] in 2010 which examined the outcomes in a series of 260 laparoscopic colectomies for diverticulitis of Hinchey classification stages I, II and III. The indications included also chronic diverticulitis, bleeding and stricture.…”

Section: Introductionmentioning

confidence: 99%

Differences in Early Outcomes after Open or Laparoscopic Surgery: What Is the Evidence?

Papagrigoriadis

2012

Dig Dis

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Laparoscopic surgery has been widely studied in colorectal cancer and its feasibility and safety have been proven to the extent that in the UK a national laparoscopic colorectal surgery programme has been established. The advantages of laparoscopic surgery have been studied less systematically in diverticular disease. Several prospective uncontrolled studies have demonstrated that laparoscopic surgery for diverticular disease is feasible with low morbidity and mortality rates. A large population study in the USA has demonstrated elective laparoscopic surgery for diverticular disease to have reduced hospital stay by 1 day, and a lower rate of intra-operative and post-operative complications over open surgery. Some of the reported differences may be attributable to selection bias of more complex cases to open surgery. A Cochrane systematic review examining 11 non-randomized and 1 randomized study showed laparoscopic surgery to be feasible in diverticular disease, although there might be a higher minor complications rate in laparoscopic resections. Attention has been focused on surgical techniques as means to reduce complications. There is a belief that preservation of the inferior mesenteric and superior rectal artery protects from anastomotic leak, but a study from the USA looking into that point did not find a difference. The application of hand-assisted laparoscopy seems to help cope with complex diverticular masses and colovesical fistulas. New hybrid techniques incorporating specimen extraction via rectum may reduce complications further. Single incision laparoscopic surgery has recently been shown to be feasible. Although minimally invasive techniques appear superior in terms of early outcomes than open surgery the choice of minimally invasive technique seems to be less relevant to outcomes if accompanied by an appropriate level of surgical experience and expertise. Patient-related factors such as comorbidities or degree of disease complexity are more likely to be related to complication rates.

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Laparoscopic Sigmoidectomy for Diverticulitis: a Prospective Study

Abstract: Results of this study suggest that laparoscopic surgery for diverticular disease is a safe, feasible, and effective management strategy.

Cited by 24 publications

References 24 publications

Quality of life in uncomplicated recurrent diverticulitis: surgical vs. conservative treatment

Quality of life in uncomplicated recurrent diverticulitis: surgical vs. conservative treatment

Optimizing laparoscopic training efficacy by ‘deconstruction into key steps’: a randomized controlled trial with novice medical students

Differences in Early Outcomes after Open or Laparoscopic Surgery: What Is the Evidence?

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