Elective Sigmoidectomy Research Articles

Robotic Sigmoidectomy for Diverticular Disease.

Introduction: Historically, colon resection was recommended after one episode of complicated diverticulitis. However, current trends favor a more individualized approach. This review examines elective sigmoidectomy for complicated diverticulitis as well as robotic approaches for diverticular disease. Methods: The literature was reviewed for timely (post 2000) and relevant articles regarding robotics and diverticulitis. The articles included large prospective series, retrospective analysis, meta-analyses and randomized controlled trials. Results: Primary anastomosis with or without protective ileostomy has emerged as an alternative to the Hartman's procedure in emergent or urgent surgery in patients without significant comorbidities. Elective sigmoidectomy after an episode of complicated diverticulitis should be decided on a case-by-case basis considering patient characteristics, continued subacute symptoms, complications from the disease, and chance of recurrence episodes. Conclusions: There are several variations techniques for robotic sigmoidectomy outlined in this article, and familiarity with all can help depending on the logistics of the case. Minimally invasive colectomy provides superior patient satisfaction and outcomes.

A Decade of Follow-Up to Assess the Risk of Recurrence and Surgery after a First Episode of Uncomplicated Left-Sided Diverticulitis

Background and aims: Acute uncomplicated diverticulitis (UD) of the left colon is common and mostly benign. Due to controversy over the definition of UD and the lack of adequate follow-up in most studies, good quality data to predict long-term outcomes after a first episode of UD are missing. The aim of this study was to assess the long-term risk for adverse outcomes after a first episode of UD. Methods: All consecutive patients with a CT-scan-documented first episode of acute UD (staged “uncomplicated” according to ESCP guidelines and/or modified Hinchey stages 0-1a, and/or CDD 1-2a) between January 2010 and June 2013 were included in the study. CT scans and clinical records were retrospectively reviewed. The primary endpoint was overall recurrence; the secondary endpoint was surgery for diverticular disease. Results: One hundred and five patients were included in the study with a median follow-up of 116.4 (4.9–154.7) months. Of these, 51 (48.5%) patients had a recurrence, 11 (10.4%) had 4 or more episodes. Twenty-one (20%) patients underwent sigmoidectomy, all in an elective setting, mostly due to multiple recurrent episodes. Male gender was the only independent risk factor for surgery (OR (95%CI): 0.301 (0.109–0.834), p = 0.021). Classification systems did not predict recurrence, but stage CDD 1a was protective for surgery (OR (95%CI): 0.201 (0.042–0.957), p = 0.044). Conclusions: After a decade of follow-up, almost half the patients experienced at least one recurrent episode after UD, higher than previously thought. None of those patients required emergency surgery, but one in five patients, mostly men, underwent elective sigmoidectomy for multiple recurrent episodes.

Diverticulitis: A Review of Current and Emerging Practice-Changing Evidence.

Acute diverticulitis represents a common colorectal emergency seen in the Western world. Over time, management of this condition has evolved. This review aims to highlight recent evidence and update current recommendations. Notable evidence has emerged in certain aspects of diverticulitis. This includes disease pathogenesis, as emerging data suggest a potentially greater role for the microbiome and genetic predisposition than previously thought. Acute management has also seen major shifts, where traditional antibiotic treatment may no longer be necessary for acute uncomplicated diverticulitis. Following successful medical management of acute diverticulitis, indications for elective sigmoidectomy have decreased. The benefit of emergency surgery remains for peritonitis, sepsis, obstruction, and acute diverticulitis in certain immunocompromised patients. Routine colonoscopy, once recommended after all acute diverticulitis episodes, has been shown to be beneficial for cancer exclusion in a distinct patient population. Despite advances in research, certain entities remain poorly understood, such as smoldering diverticulitis and symptomatic uncomplicated diverticular disease. As research in the field expands, paradigm shifts will shape our understanding of diverticulitis, influencing how clinicians approach management and educate patients.

Surgical outcomes in elective sigmoid resection for diverticulitis stratified according to indication: a propensity-score matched cohort study with 903 patients

ObjectiveWeighing the perioperative risk of elective sigmoidectomy is done regardless of the specific diverticulitis classification. The aim of this study is to evaluate surgical outcomes according to the classification grade and the indication.MethodsAll patients who underwent elective colonic resection for diverticulitis during the ten-year study period were included. They were divided into two groups: relative surgery indication (RSI) and absolute surgery indication (ASI). RSI included microabscess and recurrent uncomplicated disease. ASI included macroabscess and recurrent complicated disease. Propensity score-matching (PSM, 1:1) was performed.Results585 patients fulfilled criteria for RSI and 318 patients fulfilled criteria for ASI. In the univariate analysis, RSI patients were younger (62 vs. 67.7 years, p < 0.001), had a higher physical status (ASA score 1 or 2 in 80.7% vs. 60.8%, p < 0.001), were less immunosuppressed (3.4% vs. 6.9%, p = 0.021) and suffered less often from coronary heart disease (3.8% vs. 7.2%, p = 0.025). After PSM, 318 RSI vs. 318 ASI patients were selected; baseline characteristics results were comparable. The proportion of planned laparoscopic resection was 93% in RSI versus 75% in ASI (p < 0.001), and the conversion rate to open surgery for laparoscopic resection was 5.0% and 13.8% in RSI versus ASI, respectively (p < 0.001). Major morbidity (Clavien/Dindo ≥ IIIb) occurred less frequently in RSI (3.77% vs. 10%, p = 0.003). A defunctioning stoma was formed in 0.9% and 11.0% in RSI vs ASI, respectively (p < 0.001).ConclusionThe lower risk for postoperative morbidity, the higher chance for a laparoscopic resection and the decreased rate of stoma formation are attributed to patients with recurrent uncomplicated diverticulitis or diverticulitis including a microabscess as compared to patients with complicated diverticulitis or diverticulitis and a macroabscess, and this applies even after PSM.

Elective Sigmoidectomy Laposcopic Assisted for Sigmoid Volvulus in a Rural Setting

Elective Sigmoidectomy Laposcopic Assisted for Sigmoid Volvulus in a Rural Setting

Long-term outcomes and risk factors for diverticulitis recurrence after a successful laparoscopic peritoneal lavage in Hinchey III peritonitis.

Recently, treatment of Hinchey III diverticulitis by laparoscopic peritoneal lavage has been questioned. Moreover, long-term outcomes have been scarcely reported. Primary outcome was to determine the recurrence rate of diverticulitis after a successful laparoscopic peritoneal lavage in Hinchey III diverticulitis. Secondary outcomes were identification of associated risk factors for recurrence and elective sigmoidectomy rate. A retrospective cohort study in a tertiary referral center was performed. Patients with Hinchey III diverticulitis who underwent a successful laparoscopic peritoneal lavage between June 2006 and December 2019 were eligible. Diverticulitis recurrence was analyzed according to the Kaplan-Meier and log-rank test, censoring for death, loss of follow-up, or elective sigmoid resection in the absence of recurrence. Risk factors for recurrence were identified using Cox regression analysis. Sixty-nine patients had a successful laparoscopic peritoneal lavage (mean age: 63years; 53.6% women). Four patients had an elective sigmoid resection without recurrences. Recurrence rate was 42% (n = 29) after a median follow-up of 63months. The cumulative global recurrence at 1, 3, and 5years was 30% (95% CI, 20-43%), 37.5% (95% CI, 27-51%), and 48.9% (95% CI, 36-64%), respectively. Smoking (HR, 2.87; 95% CI, 1.22-6.5; p = 0.016) and episodes of diverticulitis prior to laparoscopic peritoneal lavage (HR, 5.2; 95% CI, 2.11-12.81; p < 0.001) were independently associated with an increased risk of recurrence. Diverticulitis recurrence after a successful laparoscopic peritoneal lavage is high, decreasing after the first year of follow-up. Smoking and previous episodes of acute diverticulitis independently increase the risk of new episodes of diverticulitis.

Recurrent Lower Abdominal Pain, Altered Bowel Habits, and Malaise: Conservative or Surgical Approach to a Common Disorder

Recurrent Lower Abdominal Pain, Altered Bowel Habits, and Malaise: Conservative or Surgical Approach to a Common Disorder

The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis

PurposeThe aim of this meta-analysis was to investigate the optimal time point of elective sigmoidectomy regarding the intraoperative and postoperative course in diverticular disease.MethodsA comprehensive literature research was conducted for studies comparing the operative outcome of early elective (EE) versus delayed elective (DE) minimally invasive sigmoidectomy in patients with acute or recurrent diverticular disease. Subsequently, data from eligible studies were extracted, qualitatively assessed, and entered into a meta-analysis. By using random effect models, the pooled hazard ratio of outcomes of interest was calculated.ResultsEleven observational studies with a total of 2096 patients were included (EE group n = 828, DE group n = 1268). Early elective sigmoidectomy was associated with a significantly higher conversion rate as the primary outcome in comparison to the delayed elective group (OR 2.48, 95% CI 1.5427–4.0019, p = 0.0002). Of the secondary outcomes analyzed only operative time (SMD 0.14, 95% CI 0.0020–0.2701, p = 0.0466) and time of first postoperative bowel movement (SMD 0.57, 95% CI 0.1202–1.0233, p = 0.0131) were significant in favor of the delayed elective approach.ConclusionsDelayed elective sigmoid resection demonstrates benefit in terms of reduced conversion rates and shortened operative time as opposed to an early approach. Conversely, operative morbidities seem to be unaffected by the timing of surgery. However, a final and robust conclusion based on the included observational cohort studies must be cautiously made. We therefore highly advocate larger randomized controlled trials with homogenous study protocols.

Surgical management in immunosuppressed patients with sigmoid diverticulitis, still a challenge: a single-center observational study

PurposeThe question of whether immunosuppressed (IS) patients should be offered elective sigmoidectomy following a single episode of diverticulitis is controversial. We intended to examine the perioperative outcome of IS and immunocompetent (IC) patients after sigmoid resection.MethodsA single institutional cohort study was conducted, including all surgically treated patients with sigmoid diverticulitis between 2004 and 2021. IS and IC patients were further subdivided into emergency and elective cases. Morbidity and mortality in both groups and factors influencing surgical outcome were examined using uni- and multivariate regression analyses.ResultsA total of 281 patients were included in the final analysis. Emergency surgery was performed on 98 patients while 183 patients underwent elective sigmoid resection. Emergency sigmoidectomy demonstrates significantly higher morbidity and mortality rates in IS patients as compared to IC patients (81.81% vs. 42.1%; p = 0.001, respectively 27.27% vs. 3.94%; p = 0.004), while major morbidity and mortality was similar in both groups in the elective setting (IS: 23.52% vs. IC: 13.85%; p = 0.488, respectively IS: 5.88% vs. IC: 0%; p = 1). On multivariate regression analysis for major postoperative morbidity, ASA score [OR 1.837; (95% CI 1.166–2.894); p = 0.009] and emergency surgery under immunosuppression [OR 3.065; (95% CI 1.128–8.326); p = 0.028] were significant. In-hospital mortality was significantly related to age [OR 1.139; (95% CI 1.012–1.282); p = 0.031], preoperative CRP count [OR 1.137; (95% CI 1.028–1.259); p = 0.013], and immunosuppression [OR 35.246; (95% CI 1.923–646.176), p = 0.016] on multivariate analysis.ConclusionsElective surgery for sigmoid diverticulitis in immunocompromised patients demonstrates higher efficacy and safety when compared to sigmoid resection in the emergency setting.

Endoscopic sigmoidopexy for recurrent sigmoid volvulus in inoperable patients: a retrospective series of 15 patients.

Recurrent sigmoid volvulus is frequent and sometimes occurs in frail patients with contraindications to surgical sigmoidectomy. Percutaneous endoscopic sigmoidopexy (PES) has recently been proposed as an alternative to elective sigmoidectomy. We aimed to describe the efficacy and safety of PES. All consecutive patients who underwent PES for recurrent sigmoid volvulus at two French centers between January 2017 and March 2021 were included in this retrospective case series. Recurrent sigmoid volvulus was defined as at least two symptomatic episodes treated by endoscopic decompression. Under endoscopic guidance, anchors were placed to attach the sigmoid to the anterior abdominal wall, allowing the placement of pigtail Chait catheters. 15 patients (60 % female; median age 74 years [range 49-96]) were included. Median number of previous sigmoid volvulus episodes was 3 (range 2-6). Procedures were technically successful with no intraprocedural adverse events for 14 patients (93 %). Peritonitis occurred at Day 2 in one patient (serious adverse event rate 7 %). Median follow-up time was 10 months (range 1-30). No sigmoid volvulus recurrence occurred during follow-up. PES using Chait catheters was feasible and effective for recurrent sigmoid volvulus and should be considered as an alternative to sigmoidectomy in inoperable patients.

What Are the Long-Term Changes to Bowel Function Patient-reported Outcomes After Elective Sigmoidectomy for Diverticular Disease?: Observational Study of Patients Undergoing Elective Sigmoidectomy for Diverticular Disease.

To evaluate long-term changes to bowel function after elective sigmoidectomy for diverticular disease. For patients with diverticular disease, choosing surgery is often based on the presumption of improvement in preoperative symptoms. Our group previously reported bowel function does not change in the early perioperative period; however, studies of long-term outcomes are limited. This is an observational study of patients that underwent elective sigmoidectomy for diverticular disease and completed the Colorectal Functional Outcome (COREFO) questionnaire before surgery. Patients were stratified into two groups based on presence or absence of a preoperative symptomatic score (i.e., total COREFO ≥ 15). Long-term bowel function (>1 year from surgery) was assessed using the COREFO questionnaire via telephone or subsequent clinic visit. Paired t-tests compared mean preoperative scores to mean long-term scores. Fifty-one patients met inclusion criteria (21 symptomatic, 30 asymptomatic). All symptomatic patients had uncomplicated disease, whereas 90% of asymptomatic patients had complicated disease. Median time from operation to questionnaire completion was 23 months (IQR = 13-34). Asymptomatic patients demonstrated impaired bowel function, predominantly driven by changes in the social impact domain. Symptomatic patients demonstrated improved bowel function, driven by changes in the incontinence, social impact, stool-related aspects, and need for medication domains. In the long-term after elective sigmoidectomy for diverticular disease, patients with symptomatic bowel function preoperatively improve substantially, while those with asymptomatic preoperative scores demonstrate statistically significant impairment. Patients determined to be symptomatic with patient-reported outcomes likely benefit long-term from sigmoid resection.Mini-Abstract: In this manuscript, long-term changes to patient-reported bowel function were assessed using a validated questionnaire after sigmoidectomy for diverticular disease. We found that in patients with symptomatic preoperative bowel function, long-term bowel function improved after elective resection. Alternatively, patients with asymptomatic preoperative bowel function demonstrated long-term impairment in bowel function.

Sigmoidectomy following sigmoid volvulus: who is at risk of anastomotic failure?

Anastomotic leak following elective sigmoidectomy performed due to sigmoid volvulus (SV) is a devastating complication. The aim of this study was to identify the incidence and risk factors associated with leak in this specific group of patients. A retrospective study was performed at two university-affiliated tertiary centres in Israel. All consecutive patients between January 2014 and April 2020 treated for SV with elective sigmoidectomy and primary anastomosis were reviewed and those suffering from anastomotic leak identified. Factors associated with this complication were assessed using univariate analysis and odds ratios subsequently calculated. Of the 99 patients initially identified, 58 were included in the study group [45 males and 13 females (77.6% versus 22.4% respectively) mean age 67.4years, range 13-97]. There were 10 anastomotic leaks identified (17.2%). On univariate analysis recurrent decompression (OR 8.28, p = 0.027), age > 80-years (OR 6.88, p = 0.027), open rather than laparoscopic surgery (OR = 5.83, p = 0.005) and ASA grade 3/4 (OR 0.132, p = 0.023) were significantly associated with anastomotic leak. Male sex approached but not reach statistical significance. Recurrent endoscopic decompression, age > 80years, open surgery and ASA grade 3/4 are associated with anastomotic leak and these patients should be considered for formation of a colostomy instead. If an anastomosis is performed, patients should be appropriately counselled and monitored in the perioperative period.

Elective minimally invasive surgery for sigmoid diverticulitis: operative outcomes of patients with complicated versus uncomplicated disease.

The aim of this work was to compare the results of elective minimally invasive surgery between patients with complicated sigmoid diverticulitis and those with uncomplicated disease. An institutional review board-approved database was searched for all consecutive patients who underwent elective minimally invasive surgery, including laparoscopic, hand-assisted and robotic sigmoidectomy, for diverticulitis between 2010 and 2017; they were classified according to the modified Hinchey classification as having complicated (abscess, fistula, stricture, obstruction, bleeding or previous perforation) versus uncomplicated disease. Data recorded included baseline demographics, indications for surgery, operative details and complications. Three hundred and twenty-five patients underwent elective sigmoidectomy for complicated (n=105) and uncomplicated (n=220) diverticulitis. Surgical indications for complicated disease were abscess (n=74), stricture (n=14), fistula (n=28) and bleeding (n=7). The two groups were statistically comparable for age, gender, body mass index and American Society of Anesthesiologists score. Patients with complicated disease had higher rates of concomitant loop ileostomy creation (9.5% vs. 0.9%, p<0.001) and synchronous resections (9.5% vs. 2.7%, p=0.01), higher volumes of blood loss (177±140 vs. 125±92ml, p<0.001), longer length of stay (5.6±3 vs. 4.8±2days, p=0.04) and longer operating time (218.2±59 vs. 185.8±63min, p<0.001). There were no significant differences in anastomotic leakage (3% vs. 1%, p=0.3), conversion to laparotomy (4.8% vs. 2.3%, p=0.3) or overall complications (36% vs. 25.9%, p=0.06) for complicated versus uncomplicated disease, respectively. Minimally invasive surgery for complicated diverticulitis resulted in higher rates of construction of proximal ileostomy and synchronous resections and longer operating times and length of hospital stay. Otherwise, it has outcomes that are not significantly different from the results recorded in patients with uncomplicated disease.

Adult sigmoid volvulus in West Africa: Management and outcome at principal hospital of Dakar

Background: Sigmoid volvulus (SV) is the commonest cause of large bowel obstruction in sub Saharan Africa. However few studies have been done in our country. Our goal was to describe the presentation, management outcome of adult SV and to evaluate our therapeutic methods in a context of non availability of endoscopic decompression.Methods: It was a retrospective, descriptive review of all adult patients, admitted in the visceral surgery department of Hospital Principal of Dakar for SV, from January 2014 to August 2018. We studied demographics variables, clinical and paraclinical features, treatment and outcome. The data were entered and analyzed using Excel 2017 software and Epi-info version 7.2.2.6.Results: We collected 103 cases of SV for 86 patients, representing 45.9% of intestinal obstruction. The mean age was 54.9 years. There were 82 males and 4 females. The mean duration of symptoms was 3.8 days. The triad acute abdominal pain, inability to pass gaz and feces, abdominal meteorism was noted in 52.4%. Plain abdominal X-ray (n=55; 53.3%) showed the classical ‘coffee bean’ sign in 69%. CT scan (n=77; 74.7%) confirmed the diagnosis in 100%. It revealed signs of intestinal gangrene in 8 cases confirmed at laparotomy in 6 cases. In 4 cases imaging was not performed.Detorsion was spontaneous in 2 cases. Faucher rectal tube decompression was performed in 81 cases with a success rate of 86.4% representing 53 patients. Elective sigmoidectomy was realized in 33 patients (31 after successful rectal tube decompression, 2 after spontaneous decompression). After elective sigmoidectomy mortality and morbidity were nil.In those with successful rectal tube decompression, 7 did not have elective sigmoidectomy for comorbidities, 12 refused the elective sigmoidectomy.Emergency surgery was performed in 34 patients: 20 patients for suspicious of complicated SV, 14 patients after failure of rectal tube decompression. It was 9 (26.4%) one stage sigmoidectomy, 24 (70.5%) 2 stage sigmoidectomy, 1 surgical detorsion without pexy. Mortality and mortality after emergency surgery were respectively 8.3% and 14.7%. After 2 stage sigmoidectomy, 86.3% benefited from a restoration of digestive continuity.During the follow-up, no recurrence occurred in patients who were operated. Conclusion: SV is a middle-age man pathology in sub Saharan Africa. In uncomplicated SV rectal tube decompression followed by elective sigmoidectomy is a good option.

Predictive model estimating the decrease of postoperative gastrointestinal quality of life index (GIQLI) in patients after elective laparoscopic sigmoid resection for diverticular disease

BackgroundGrowing consideration in quality of life (QoL) has changed the therapeutic strategy in patients suffering from diverticular disease. Patients’ well-being plays a crucial role in the decision-making process. However, there is a paucity of studies investigating patients’ or surgery-related factors influencing the postoperative gastrointestinal function. The aim of this study was to investigate in a predictive model patients or surgical variables that allow better estimation of the postoperative gastrointestinal QoL.MethodsThis observational study retrospectively analyzed patients undergoing elective laparoscopic sigmoidectomy for diverticulitis between 2004 and 2017. The one-time postoperative QoL was assessed with the gastrointestinal quality of life index (GIQLI) in 2019. A linear regression model with stepwise selection has been applied to all patients and surgery-related variables.ResultsTwo hundred seventy-two patients with a mean age of 62.30 ± 9.74 years showed a mean GIQLI of 116.39±18.25 at a mean follow-up time of 90.4±33.65 months. Women (n=168) reported a lower GIQLI compared to male (n=104; 112.85±18.79 vs 122.11±15.81, p<0.001). Patients with pre-operative cardiovascular disease (n=17) had a worse GIQLI (106.65 ±22.58 vs 117.08±17.66, p=0.010). Finally, patients operated less than 5 years ago (n=63) showed a worse GIQLI compared to patients operated more than 5 years ago (n=209; 111.98±19.65 vs 117.71±17.63, p=0.014).ConclusionsFemale gender and the presence of pre-operative cardiovascular disease are predictive for a decreased postoperative gastrointestinal QoL. Furthermore, patients’ estimation of gastrointestinal functioning seems to improve up to 5 years after surgery.Graphical abstract

What Are the Long-Term Changes to Bowel Function Patient-Reported Outcomes after Elective Sigmoidectomy for Diverticular Disease?

What Are the Long-Term Changes to Bowel Function Patient-Reported Outcomes after Elective Sigmoidectomy for Diverticular Disease?

Quality of Life After Elective Laparoscopic Sigmoidectomy for Symptomatic Uncomplicated Diverticular Disease.

Symptomatic uncomplicated diverticular disease (SUDD) is characterized by abdominal pain and altered bowel function and may affect quality of life. When symptoms are severe and conservative therapy is ineffective, surgical intervention becomes an option. This study aims to investigate quality of life after elective sigmoidectomy for patients affected by SUDD. Retrospective multicenter review of consecutive patients affected by SUDD that underwent elective laparoscopic sigmoidectomy from January 2015 to March 2018. SUDD was defined as the presence of diverticula with persistent localized pain and diarrhea or constipation without macroscopic inflammation. Quality of life was investigated using the Gastrointestinal Quality of Life Index questionnaire at baseline, and at 6 and 12 months after surgery. Readmissions, unplanned clinical examination, mesalazine resumption, and emergency department visit for abdominal symptoms were recorded. Fifty-two patients were included in the analysis. Gastrointestinal Quality of Life Index score at 6 months from surgery did not statistically differ from baseline (96±10.2 vs. 89±11.2; P>0.05), while patients reported a better quality of life at 12 months after surgery (109±8.6; P<0.05). Within the first year of follow-up, 3 patients (5.8%) were readmitted for acute enteritis, 8 patients (15.4%) had emergency room access for abdominal pain, and 8 patients had unplanned outpatients' medical examinations for referred lower abdominal pain and bowel changes. Mesalazine was resumed in 17.3% of patients. Elective laparoscopic sigmoidectomy for SUDD is safe and effective in improving quality of life, although in some cases symptoms may persist.

Quality of life in uncomplicated recurrent diverticulitis: surgical vs. conservative treatment

Elective sigmoid colectomy for recurrent uncomplicated diverticulitis remains controversial and is decided on an individual basis. Eighty patients treated conservatively (44 patients) or by elective surgery (36 patients) for recurrent uncomplicated diverticulitis were contacted and assessed for quality of life. The mean difference in quality of life scores was greater after surgery (overall + 2.14%, laparoscopic resection +4.95%, p = 0.36 and p = 0.11, respectively) as compared to conservative management. Female patients undergoing laparoscopic resection had statistically significantly higher quality of life scores than women treated conservatively (+8.98%; p = 0.049). Twenty-eight of 29 responding patients stated that they were highly satisfied and would have the operation done again. Elective sigmoidectomy is a valid treatment option for recurrent uncomplicated diverticulitis in terms of quality of life. Quality of life improved most if surgery was performed laparoscopically, especially in women.

No need to watch the clock: persistence during laparoscopic sigmoidectomy for diverticular disease.

Laparoscopic sigmoidectomy is the preferred approach in the elective surgical management of diverticulitis. However, it is unclear if the benefits of laparoscopy persist when operative times are prolonged. We aimed to investigate if the recovery benefits associated with laparoscopy are retained when operative times are long. A retrospective review of a prospectively maintained database of patients who underwent elective laparoscopic sigmoidectomy from 2010-2015 at a single academic tertiary institution was performed. Operative times among laparoscopic completed cases were divided into quartiles, and patient outcomes were compared between the groups. A total of 466 patients (median age: 58 ± 11.6years, 58% females) underwent sigmoidectomy: 430 completed laparoscopically and 36 (7.7%) converted. Median operative time in laparoscopically completed cases was 188min (IQR 154-230). There were no differences in morbidity (P = 0.52) or readmission rates (P = 0.22) among the quartiles. The 2nd and 4th operative time quartiles were associated with significantly longer length of stay (LOS) when compared to the fastest quartile (P = 0.003 and P = 0.002, respectively), but there was no increase in LOS as operative times progressed between the 2nd, 3rd, and 4th quartiles. LOS after conversion was longer but did not reach statistical significance when compared to laparoscopically completed operations in the longest quartile (5.0 vs 6.5days, P = 0.075) CONCLUSIONS: Our data do not support preemptive conversion of laparoscopic sigmoidectomy to avoid prolonged operative times. As long as progress is safely being made, surgeons are justified to continue pursuing laparoscopic completion.

PREDICtors for health-related quality of life after elective sigmoidectomy for DIVerticular disease: the PREDIC-DIV study protocol of a prospective multicentric transnational observational study

IntroductionDiverticulitis is among the most common abdominal disorders. The best treatment strategy for this complicated disease as well as for recurrent stages is still under debate. Moreover, little knowledge exists...