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Laparoscopic approach to Diverticulitis. Scheibach et al., 2004

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25/05/2006

Dis Colon Rectum. 2004 Nov;47(11):1883-8. Related Articles, Links

Laparoscopic approach to treatment of sigmoid diverticulitis: changes in the spectrum of indications and results of a prospective, multicenter study on 1,545 patients.

Scheidbach H, Schneider C, Rose J, Konradt J, Gross E, Barlehner E, Pross M, Schmidt U, Kockerling F, Lippert H.

Department of Surgery, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany. scheidbach@t-online.de

BACKGROUND: The aim of the present study was to analyze changes regarding the indications for and results of laparoscopic treatment of sigmoid diverticulitis. METHODS: The data were collected within the framework of an ongoing prospective multicenter study carried out by the Lapa roscopic Colorectal Surgery Study Group and were submitted to a statistical subgroup analysis. The institutions participating in the study were divided into three groups by experience (Group I, >100 procedures; Group II, 30-100 procedures; Group III, < 30 procedures).

RESULTS: Among the 3,868 recruited patients, sigmoid diverticulitis (n = 1,545, 40 percent) was by far the most common indication for surgery, and sigmoid resection (n = 2,160, 55.9 percent) was by far the most common laparoscopic procedure. A total of 1,353 patients (87.6 percent) had uncomplicated diverticulitis, whereas 192 (12.4 percent) had a complicated form of diverticular disease (Hinchey I-IV, diverticular bleeding, fistula formation). Cases of complicated diverticulitis were significantly more frequently operated on at institutions with greater experience (Group I, 20.8 percent; Group II, 8.7 percent; Group III, 7.9 percent). Despite this fact, these institutions still had better intraoperative complication rates (Group I, 5.0 percent; Group II, 5.8 percent; Group III, 6.9 percent), conversion rates (Group I, 4.4 percent; Group II, 6.7 percent; Group III, 7.7 percent), and postoperative morbidity (Group I, 15.9 percent; Group II, 16.6 percent; Group III, 18.6 percent) and mortality (Group I, 0.2 percent; Group II, 0.5 percent; Group III, 0.4 percent) rates.

CONCLUSION: An increase in experience is associated with an expansion of laparoscopic indications to include complicated forms of diverticulitis, with comparable ntraoperative and postoperative complication rates, operating time, and mortality rates.

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