Long-Term Functional Results of a Modified Caudal-to-Cranial Approach in Laparoscopic Segmental Left Colectomy for Diverticular Disease.

Michele Manigrasso,Marco Milone,Francesco Maione,Giovanni Sarnelli,Giovanni Galasso,Marcella Pesce,Pietro Anoldo,Giovanni Domenico De Palma,Nicola Gennarelli,Anna D’amore

doi:10.1155/2021/8940682

Michele Manigrasso, Marco Milone + Show 8 more

Open Access

https://doi.org/10.1155/2021/8940682

Copy DOI

Abstract

A modified caudal-to-cranial approach to perform laparoscopic left colectomy for benign diseases has been recently designed to facilitate the low-tie mesenteric dissection. A chart review has been performed including all consecutive patients with uncomplicated diverticulitis who have been treated by segmental left colectomy with a caudal-to-cranial approach. A total of 34 patients were included in the study. 21 patients were male, mean age was 54.1 ± 11.3, and mean BMI was 26 ± 5.5. Patients with ASA Score I were 7, with ASA II were 9, and with ASA Score III were 5. Incontinence Score (IS) resulted in an average of 5 ± 2, 2 grade of incontinence and the CS score showed an average of 10 ± 3, 2 grade of constipation. Health status, evaluated by Short Form-36 questionnaire, was demonstrated in these patients' great physical function, role, general health, and social function. The anorectal manometry performed 6 months after surgery showed a normal value in terms of the anal resting pressure (47 ± 13 mmHg) and an increased volume to stimulate desire to defecate (197 ± 25 ml). The length of the anal sphincter was normal compared to the reference value (37 ± 5.4 mm). Although further studies are required to obtain definitive conclusions, our results are encouraging to propose low-tie segmental colectomy as the standard procedure for the treatment of uncomplicated diverticulitis, and our modified surgical approach could be considered useful to facilitate the surgical approach.

Highlights

Diverticular disease (DD) represents the fifth most important gastrointestinal disease in Western countries with an estimated mortality of 2.5/100000 per year [1]
A chart review has been performed including all consecutive patients with uncomplicated diverticulitis who have been treated by segmental left colectomy with a caudal-to-cranial approach
Surgical treatment remains the gold standard in the case of complicated diverticulitis (Hinchey Classification Stage III and IV), the optimal management for treating uncomplicated diverticulitis is still under debate

Summary

Introduction

Diverticular disease (DD) represents the fifth most important gastrointestinal disease in Western countries with an estimated mortality of 2.5/100000 per year [1]. Surgical treatment remains the gold standard in the case of complicated diverticulitis (Hinchey Classification Stage III and IV), the optimal management for treating uncomplicated diverticulitis is still under debate. Previous guidelines recommended to undergo surgery for the patients after two attacks of acute diverticulitis. New guidelines recommend to consider surgery on a “case-by-case basis,” according to patients’ quality of life [2]. The surgical treatment of choice to approach uncomplicated diverticular disease remains laparoscopic sigmoidectomy. A modified caudal-to-cranial approach to perform laparoscopic left colectomy for benign diseases has been recently designed to facilitate the low-tie mesenteric dissection [3]. The mesenteric resection close to the colonic wall has been demonstrated to guarantee better functional results, i.e., reduction of the incidence of defecatory disorders and less

Methods

Results

Conclusion