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

Abstract

Aim: Increasing attention has been given to postoperative gastrointestinal functional outcome and quality of life after sigmoid resection for diverticulitis. Conversely, very little has been described about postoperative urogenital functional outcome and even less about its potential relationship to the type of vascular approach. The aim of this study was to evaluate whether central ligation of the inferior mesenteric artery (IMA) compared with peripheral dissection could impair urinary and sexual function in the long term.Method: Patients undergoing elective laparoscopic sigmoid resection for diverticulitis from 2004 to 2017 were retrospectively analysed. They were asked to complete the American Urological Association Symptom Index (AUASI) questionnaire. Men received the five-item version of the International Index of Erectile Function (IIEF-5) questionnaire. Patients were then divided according to the type of vascular resection. Results:A response rate of the 36.4% to the AUASI and 43.8% to the IIEF-5 questionnaires was achieved. Three hundred and twenty four patients with a mean age of 62 ± 9.85 years were analysed for their urinary function (IMA preserved n = 217; IMA resected n = 107) in a median follow-up of 87 months. Furthermore, 115 men with a mean age of 60 ± 8.97 years were investigated for their sexual function (IMA preserved n = 80; IMA resected n = 35) in a median follow-up of 89 months. No difference (AUASI: 8 ± 6.32 IMA preserved vs. 7 ± 6.26

The Dilemma of the Level of the Inferior Mesenteric Artery Ligation in the Treatment of Diverticular Disease: A Systematic Review of the Literature

“…After the initial screening of titles and abstracts and removal of duplicated, 318 titles remained, of which 29 were evaluated as full text (Figure 1). Twelve studies met the inclusion criteria [17][18][19][20][21][22][23][24][25][26][27][28] and were included in the meta-analysis: 3 RCTs and 9 non-RCTs. Studies included a total of 2812 pooled patients as follows: 1612 underwent IMA ligation (IL) versus 1200 with IMA preservation (IP) (Table 1).…”

“…The vascular control was achieved close to the colonic wall in 176 patients, 15.23%) [18,21,25], by ligation of the sigmoid vessels (287 patients, 19.12%) [24,26,27] and by Valdoni's IMA skeletonization technique (262 patients, 22.66%) [17,23,28]. Most cases were extracted from the two articles of Posabella et coll., which included both techniques, dissection of the sigmoid vessels and peripheral dissection close to the colonic wall (497 patients, 42.99%) [19,20] (Table 2).…”

“…Regarding the bias due to confounding factor, five studies did not report the severity of acute diverticulitis [17,22,23,25,26]; it was therefore impossible to evaluate the presence of an unequal distribution of this additional risk factor between the study groups; one study described the same rate of severity of acute diverticulitis reaching a low risk of bias [27]. On the contrary, three other studies were assessed with moderate risk of overall bias [19][20][21]. In both studies by Posabella, the rate of recurrent diverticulitis with covered perforation was higher in the IP group [19,20].…”

“…On the contrary, three other studies were assessed with moderate risk of overall bias [19][20][21]. In both studies by Posabella, the rate of recurrent diverticulitis with covered perforation was higher in the IP group [19,20]. In the study of Borchert, the characteristics of patients based on the Hansen-Stock classification of acute diverticulitis are very different, with the highest severity being reported in the IP group [21].…”

Laparoscopic left colic artery preserving sigmoidectomy for diverticulitis in a patient with urinary tract malformation ‐ a video vignette

“…Minimally invasive surgery should be considered nowadays as the gold standard treatment for colorectal disease [1,2]. Sigmoidectomy is considered the treatment of choice for diverticulitis, being associated with a low rate of postoperative morbidity and good functional results [3][4][5].…”