Abstract
BackroundDiverticulosis is a common disease in the western society with an incidence of 33–66%. 10–25% of these patients will develop diverticulitis. In order to prevent a high-risk acute operation it is advised to perform elective sigmoid resection after two episodes of diverticulitis in the elderly patient or after one episode in the younger (< 50 years) patient. Open sigmoid resection is still the gold standard, but laparoscopic colon resections seem to have certain advantages over open procedures. On the other hand, a double blind investigation has never been performed. The Sigma-trial is designed to evaluate the presumed advantages of laparoscopic over open sigmoid resections in patients with symptomatic diverticulitis.MethodIndication for elective resection is one episode of diverticulitis in patients < 50 years and two episodes in patient > 50 years or in case of progressive abdominal complaints due to strictures caused by a previous episode of diverticulits. The diagnosis is confirmed by CT-scan, barium enema and/or coloscopy.It is required that the participating surgeons have performed at least 15 laparoscopic and open sigmoid resections. Open resection is performed by median laparotomy, laparoscopic resection is approached by 4 or 5 cannula. Sigmoid and colon which contain serosal changes or induration are removed and a tension free anastomosis is created. After completion of either surgical procedure an opaque dressing will be used, covering from 10 cm above the umbilicus to the pubic bone. Surgery details will be kept separate from the patient's notes.Primary endpoints are the postoperative morbidity and mortality. We divided morbidity in minor (e.g. wound infection), major (e.g. anastomotic leakage) and late (e.g. incisional hernias) complications, data will be collected during hospital stay and after six weeks and six months postoperative. Secondary endpoints are the operative and the postoperative recovery data. Operative data include duration of the operation, blood loss and conversion to laparotomy. Post operative recovery consists of return to normal diet, pain, analgesics, general health (SF-36 questionnaire) and duration of hospital stay.DiscussionThe Sigma-trial is a prospective, multi-center, double-blind, randomized study to define the role of laparoscopic sigmoid resection in patients with symptomatic diverticulitis.
Highlights
The Sigma-trial is a prospective, multi-center, double-blind, randomized study to define the role of laparoscopic sigmoid resection in patients with symptomatic diverticulitis
Diverticulosis is a common disease in the western society with an overall incidence of 33% in the population > 45 years of age and increasing to 66% in the population older than 85 years of age [1,2]. 10–25% of patients with diverticulosis will develop diverticulitis [3,4]
Treatment of diverticulitis is based on the severity of the disease, which can be staged by the Hinchey criteria, shown in table 1[58]
Summary
Diverticulosis is a common disease in the western society with an overall incidence of 33% in the population > 45 years of age and increasing to 66% in the population older than 85 years of age [1,2]. 10–25% of patients with diverticulosis will develop diverticulitis [3,4]. 10–25% of patients with diverticulosis will develop diverticulitis [3,4]. Treatment of diverticulitis is based on the severity of the disease, which can be staged by the Hinchey criteria, shown in table 1[58]. Most patients with stage I and II disease can be treated conservatively with bed rest, starvation, intra venous fluids and intra venous antibiotics. The inflamed bowel, mostly the sigmoid, has to be resected with or without creating a primary anastomosis. Mortality in these patients is relatively high, 6 to 22%, due to the severity of the disease [8]
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