The cost effectiveness of elective laparoscopic sigmoid resection for symptomatic diverticular disease: financial outcome of the randomized control Sigma trial

Coupé, Veerle M.H.; Peet, Donald L. van der; Cuesta, Miguel A.

doi:10.1007/s00464-010-1252-2

Cited by 27 publications

(12 citation statements)

References 27 publications

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“…Lower costs for hospitalization (2983 vs. 3598 €), blood products (87 vs. 240 €), paramedical services (157 vs. 278 €), and emergency attendance (72 vs. 115 €) in the LSR group partially compensated these increased operation costs. Taken together, the authors concluded that total healthcare costs for laparoscopic and open sigmoid resection were similar and that patients should, therefore, be preferentially treated laparoscopically given its other advantages [18] (level of evidence: 2a).…”

Section: Minimally Invasive Surgery For Elective Treatment Of Divertimentioning

confidence: 96%

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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Section: Minimally Invasive Surgery For Elective Treatment Of Divertimentioning

confidence: 96%

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

2015

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“…Laparoscopy was associated with less pain and higher quality of life scores in the short term, while 6-month follow-up showed no difference in late complications or recurrence. 49 In a financial analysis, the cost of a 1% complication reduction attributable to laparoscopy was a mere €31, making laparoscopic approach a bargain for patients and hospitals. 49 A subsequent study in 2010 with similar design showed no difference in complication rates between laparoscopic (13.5%) and open (9%) groups, reduced perception of pain in laparoscopy and similar quality-of-life scores aside from cosmesis.…”

Section: Elective Resection For Diverticulitismentioning

confidence: 99%

“…49 In a financial analysis, the cost of a 1% complication reduction attributable to laparoscopy was a mere €31, making laparoscopic approach a bargain for patients and hospitals. 49 A subsequent study in 2010 with similar design showed no difference in complication rates between laparoscopic (13.5%) and open (9%) groups, reduced perception of pain in laparoscopy and similar quality-of-life scores aside from cosmesis. 50,51 Patients undergoing conversion experienced worsened outcomes, making patient selection an important factor for better outcomes.…”

Section: Elective Resection For Diverticulitismentioning

confidence: 99%

Complicated Diverticular Disease

Coakley

Davis

Kasten

2020

Clin Colon Rectal Surg

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The modern management of colonic diverticular disease involves grouping patients into uncomplicated or complicated diverticulitis, after which the correct treatment paradigm is instituted. Recent controversies suggest overlap in management strategies between these two groups. While most reports still support surgical intervention for the treatment of complicated diverticular disease, more data are forthcoming suggesting complicated diverticulitis does not merit surgical resection in all scenarios. Given the significant risk for complication in surgery for diverticulitis, careful attention should be paid to patient and procedure selection. Here, we define complicated diverticulitis, discuss options for surgical intervention, and explain strategies for avoiding operative pitfalls that result in early and late postoperative complications.

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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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The cost effectiveness of elective laparoscopic sigmoid resection for symptomatic diverticular disease: financial outcome of the randomized control Sigma trial

Cited by 27 publications

References 27 publications

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

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

Complicated Diverticular Disease

Overtreatment of Sigmoid Diverticulitis: Plea for a Less Aggressive Approach

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