Laparoscopic sigmoid colectomy after acute diverticulitis: When to operate?

Abstract

Laparoscopic sigmoid colectomy has become an acceptable method of surgical treatment for diverticulitis. However, an optimal waiting period before attempting elective laparoscopic colectomy has not been established. We sought to evaluate the relationship between the time interval from an acute episode of diverticulitis to laparoscopic colectomy and surgical outcomes. All patients undergoing laparoscopic colectomy during a period of 10 years in a single institution were studied. Retrospectively collected data included patient demographics, American Society of Anesthesiologists score, prior episodes of diverticulitis, interval between last attack and operation, operative time, complications, conversion, and recovery period. A total of 120 patients were included; 89 had a primary diagnosis of diverticulitis. Mean interval from acute diverticulitis to operation was 64 days (range, 1 to 240). Median number of episodes of diverticulitis before colectomy was 3 (range, 1 to 10). Ten patients (11%) required conversion from laparoscopic to open colectomy. Neither interval from acute attack to operation nor number of prior episodes of diverticulitis was associated with any significantly increased rate of conversion to open colectomy, complication rate, operative time, or recovery period (P=not significant). Our study showed no direct relationship between surgical timing after acute diverticulitis and complication or conversion rates after elective laparoscopic sigmoid colectomy.