Role of minimally invasive surgery in the treatment of diverticular disease: an evidence-based analysis

Abstract

The clinical spectrum of diverticular disease varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications, such as perforation or bleeding. While the presence of diverticula is common, symptomatic diverticulitis is relatively uncommon, occurring in an estimated 10-30 % of patients. There is continued debate as to whether patients should undergo elective resection for diverticular disease and regarding the role of minimally invasive surgery. Since the first publication on laparoscopic colorectal procedures, the interest in minimally invasive surgery has kept growing. Laparoscopic sigmoid resection with restoration of continuity is currently the prevailing modality for treating acute and recurrent sigmoid diverticulitis. However, it still remains unclear whether laparoscopy should be recommended also for complicated sigmoid diverticulitis. The potential benefits of reduced pain and analgesic requirements, smaller scars, and shorter hospital stay but longer operative times are appealing to both patients and surgeons. Nevertheless, there many concerns regarding the time and the type of surgery. Although the role of minimally invasive surgery in the treatment of colonic diseases is progressively increased, current randomized controlled trials should demonstrate whether laparoscopic lavage, Hartmann's procedure or resection and anastomosis achieve the best results for patients. This review aimed to analyze the results of laparoscopic colonic resection for patients with uncomplicated and complicated forms of sigmoid diverticular disease and to determine what stages profit from a laparoscopic procedure and whether the approach can be performed with a low complication rate even for patients with complicated forms of the disease.

Introductory Chapter: Diverticular Disease and Complications

“…Luis Rodrigo Internal Medicine Department, Oviedo University, Oviedo, Spain *Address all correspondence to: lrodrigosaez@gmail.com When bleeding originates from a diverticulum and a colonoscopy is performed after adequate preparation, stigmata of recent bleeding may be identified, including the presence of a visible nonbleeding vessel or firmly adherent clot in a diverticulum. These endoscopic stigmata may be present in 30-40% of patients with diverticular hemorrhage [12].…”

Spiral CT Image Post-Processing Technology to Guide Hypertensive Cerebral Hemorrhage in Minimally Invasive Removal

“…Therefore, it must be carefully compared with the cross-sectional image. Three-dimensional reconstruction can be divided into linear reconstruction, surface reconstruction (SSD) and volume reconstruction (VRT) [13]. VRT is to give all the crystal elements in the data according to different brightness percentages and different color transparency and gray levels.…”