Short-term outcomes after elective minimally invasive colectomy for diverticulitis

Pendlimari, Rajesh; Touzios, John G.; Azodo, Ijeoma A; Chua, Heidi K; Dozois, Eric J.; Cima, Robert R.; Larson, Dirk

doi:10.1002/bjs.7345

Cited by 36 publications

(22 citation statements)

References 17 publications

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“…Many studies found that severity of disease was a predictor for conversion, 5,21,37,47-50 but others could not demonstrate a significant difference. 22,51,52 Conversion has traditionally been associated with higher morbidity, 6,7,53 but this has been challenged. 5,37 In a multi-center prospective study of laparoscopic management of diverticulitis, Scheidbach et al found that complication and conversion rates were initially higher in complicated disease but improved with surgeon experience.…”

Section: Management Of Diverticular Diseasementioning

confidence: 99%

“…[16][17][18][19][20] Other studies have not used a total laparoscopic approach but have performed technically challenging aspects with a resection-facilitated or hand-assisted technique. 4,[21][22][23] While these techniques improve operating times and preserve tactile feedback, their outcomes may not be comparable with a totally laparoscopic technique with intracorporeal suturing, and the inherent benefits of minimally invasive surgery are reduced.…”

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confidence: 99%

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Laparoscopic Management of Diverticular Colovesical Fistula: Experience in 15 Cases and Review of the Literature

Marney

2013

International Surgery

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Colovesical fistulas secondary to diverticular disease may be considered a contraindication to the laparoscopic approach. The feasibility of laparoscopic management of complicated diverticulitis and mixed diverticular fistulas has been demonstrated. However, few studies on the laparoscopic management of diverticular colovesical fistulas exist. A retrospective analysis was performed of 15 patients with diverticular colovesical fistula, who underwent laparoscopic-assisted anterior resection and bladder repair. Median operating time was 135 minutes and median blood loss, 75 mL. Five patients were converted to an open procedure (33.3%) with an associated increase in hospital stay (P ¼ 0.035). Median time to return of bowel function was 2 days and median length of stay, 6 days. Overall morbidity was 20% with no major complications. There was no mortality. There was no recurrence during median follow-up of 12.4 months. These results suggest that laparoscopic management of diverticular colovesical fistulas is both feasible and safe in the setting of appropriate surgical expertise.

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Section: Management Of Diverticular Diseasementioning

confidence: 99%

mentioning

confidence: 99%

Laparoscopic Management of Diverticular Colovesical Fistula: Experience in 15 Cases and Review of the Literature

Marney

2013

International Surgery

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“…Also Pendlimari et al [32], comparing 136 patients underwent laparoscopic surgery for complicated diverticulitis (including also open perforation, fistula, stricture and bleeding) with 225 patients with uncomplicated disease, found no difference in morbidity, mortality, bowel recovery and conversion rate. Differences in overall morbidity (42 vs. 19.9 %; p = 0.002), wound infection (22 vs. 8.2 %; p = 0.007) and length of stay (6.5 vs. 4.8 days; p \ 0.001) were still found between converted and un-converted group, regardless of whether or not complicated.…”

Section: Hinchey I and Ii Acute Diverticulitismentioning

confidence: 97%

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

2015

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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.

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“…In einer großen Analyse einer multizentrischen Datenbank mit 6970 Patienten konnten signifikant niedrigere Komplikationen für das laparoskopische Vorgehen gezeigt werden [30]. Im Vergleich zwischen komplizierter (n = 136) und unkomplizierter Divertikulitis (n = 225) fanden Pendlimari et al [31] …”

Section: Technische Aspekte Und Zeitpunkt Der Operationunclassified

Operationsindikation bei Divertikulitis – Gibt es neue Daten?

Weimann

Hirsch²,

Schiefke

2012

Zentralbl Chir

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The treatment in acute diverticulitis has undergone a considerable shift from an offensive to a more restrictive and individual indication for surgery. This review of the very recent literature with special regard to long-term observation of conservatively treated patients clearly shows that surgery is not required in any case of a first episode of severe diverticulitis, but should be recommended in high-risk patients under immunosuppression or chronic renal failure. In all other groups of patients the indication for surgery should be weighed on an individual basis after each episode, again aiming for the laparoscopic procedure. A therapeutic algorithm is proposed according to the Hansen-Stock classification.

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Short-term outcomes after elective minimally invasive colectomy for diverticulitis

Abstract: Elective minimally invasive colectomy is feasible for patients with uncomplicated and complicated diverticulitis, with equivalent outcomes.

Cited by 36 publications

References 17 publications

Laparoscopic Management of Diverticular Colovesical Fistula: Experience in 15 Cases and Review of the Literature

Laparoscopic Management of Diverticular Colovesical Fistula: Experience in 15 Cases and Review of the Literature

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

Operationsindikation bei Divertikulitis – Gibt es neue Daten?

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