Lessons Learned From the Analysis of 200 Laparoscopic Sigmoid Resections for Diverticulitis

Zehetner, Jörg; Szabó, K; Wayand, W.; Shamiyeh, Andreas

doi:10.1097/sle.0b013e3181a091eb

Cited by 7 publications

(5 citation statements)

References 21 publications

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“…We attribute this low rate to our early laparoscopic experience. Our conversion rate can be compared favorably with that reported in other laparoscopic studies ( Table 6 1,8,10,13,22,23,24,28 ) . The main reasons for conversion were the intense inflammatory process, anatomic difficulties, and previous surgery in cases of Hinchey III (11 cases), Hinchey IIa (1 case), and Hinchey I (2 cases), and anastomotic failure in one case.…”

Section: Discussionsupporting

confidence: 77%

See 1 more Smart Citation

Laparoscopic Sigmoidectomy for Diverticulitis: a Prospective Study

Elgazwi¹,

Baća²,

L³

et al. 2010

JSLS

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Section: Discussionsupporting

confidence: 77%

“…In a meta-analysis comparing hand-sewn and stapled anastomosis 28 after open surgery, postoperative strictures were more common in the stapled group. In our study, stricture of the anastomosis occurred in 2 patients (0.7%).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Sigmoidectomy for Diverticulitis: a Prospective Study

Elgazwi¹,

Baća²,

L³

et al. 2010

JSLS

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“…Laparoscopy offers many advantages over laparotomy including decreased tissue trauma, decreased postoperative pain, and a lower rate of surgical or postoperative complications . There are 3 main approaches for establishment of pneumoperitoneum for laparoscopy: the open technique (Hasson or modified Hasson), closed approach, and modified blind entry technique.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Tissue Impedance Measurement Interpretation for Correct Veress Needle Placement in Feline Cadavers

et al. 2013

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Failure of TIMI to identify placement in the retroperitoneal fat pad resulted in poor accuracy. Small cat size limited the number of appropriate placement sites, perhaps resulting in excessively dorsal placements. Use of TIMI may increase detection of clinically significant inappropriate Veress needle placements, like bowel perforations, and decrease installment phase complications. Further evaluation of Veress needle placement with and without TIMI is warranted.

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“…Laparoscopic resection for both symptomatic and perforated diverticulitis have been shown to be as safe and effective as conventional open techniques [41,42] and the results of a cost-effectiveness analysis of a laparoscopic approach compared with open sigmoid resection were similar [43,44]. …”

Section: Development In Managementmentioning

confidence: 99%

Overtreatment of Sigmoid Diverticulitis: Plea for a Less Aggressive Approach

Daniels

Korte

Winter

et al. 2012

Dig Dis

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A less invasive approach to the treatment of left-sided colonic diverticulitis has emerged in the last decade. The standard of care for perforated or complicated diverticulitis evolved from a Hartmann’s procedure, to resection and primary anastomosis, to treatment with antibiotics and percutaneous drainage in a carefully selected (Hinchey grade 2) patient subset. Recently, laparoscopic lavage emerged as a promising less invasive treatment for selected cases of Hinchey 3 patients. Likewise, for nonperforated or uncomplicated diverticulitis the approach is becoming less aggressive with a change from intravenous antimicrobial therapy, starvation and admission, to oral antibiotics and finally to observation and outpatient treatment. This less invasive or aggressive approach is due to expanding evidence on optimal treatment and is congruent with an increasing understanding that diverticulitis comprises different disease entities with heterogeneity between patients. The disease should be targeted by specific approaches, after a meticulous assessment of the diverticulitis stage, and tailored to an individual basis. Avoidance of overtreatment has obvious benefits: less in-hospital treatment, cost reduction, diminished development of antimicrobial resistance, reduction in complication rate and side effects and presumably a better quality of life for the patient. In conclusion, one might say we have overtreated the majority of diverticulitis patients for decades. More research is needed to explain the pathogenesis and multifactorial etiology and in the near future hopefully several unanswered questions regarding the optimal management of patients with different stages of diverticulitis will be answered by various ongoing trials.

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Lessons Learned From the Analysis of 200 Laparoscopic Sigmoid Resections for Diverticulitis

Abstract: Laparoscopic sigmoid resections for diverticulitis can be performed with great safety and low conversion rate. Several adjustments in operation technique and perioperative management had to be done to achieve a complication rate and conversion rate at an acceptable low level.

Cited by 7 publications

References 21 publications

Laparoscopic Sigmoidectomy for Diverticulitis: a Prospective Study

Laparoscopic Sigmoidectomy for Diverticulitis: a Prospective Study

Diagnostic Accuracy of Tissue Impedance Measurement Interpretation for Correct Veress Needle Placement in Feline Cadavers

Overtreatment of Sigmoid Diverticulitis: Plea for a Less Aggressive Approach

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