Right-sided Diverticulitis Research Articles

Right-Sided Diverticulitis Requiring Colectomy: an Evolving Demographic? A Review of Surgical Outcomes from the National Inpatient Sample Database

IntroductionThere remains a paucity of recent data on right-sided colonic diverticulitis, especially those undergoing colectomy. We sought to describe the clinical features of patients undergoing both a laparoscopic and open surgery for right-sided diverticulitis. MethodsThis study is a review of all cases of a right colectomy or ileocecectomy for diverticulitis from the National Inpatient Sample (NIS) from 2006 to 2012. Demographics, comorbidities, and postoperative outcomes were identified for all cases. A comparative analysis of a laparoscopic versus open approach was performed. ResultsWe identified 2233 admissions (laparoscopic = 592; open = 1641) in the NIS database. The majority of cases were Caucasian (67 %), with 6 % of NIS cases identified as Asian/Pacific Islander. The overall morbidity and in-hospital mortality rates were 24 and 2.7 %, respectively. The conversion rate from a laparoscopic to open procedure was 34 %. Postoperative complications were greater in the open versus laparoscopic cohorts (25 vs. 19 %, p < 0.01), with pulmonary complications as the highest (7.0 vs. 1.7 %; p < 0.01). ConclusionThis investigation represents one of the largest cohorts of colon resections to treat right-sided diverticulitis in the USA. In this series, right-sided diverticulitis undergoing surgery occurred most commonly in the Caucasian population and is most often approached via an open surgical technique; however, laparoscopy is a safe and feasible option.

Higher Mortality in Surgically Managed Diverticulitis is Associated with Asian Ethnicity and Right-Sided Disease.

Although right-sided diverticulitis is perceived to have a higher incidence among Asians and infrequently requires surgical management in comparison with sigmoid diverticulitis, it is unknown whether differences in outcomes are due to ethnic disparity or disease pathophysiology. The aim of this study was to determine the surgical outcomes for Asian and non-Asian patients with diverticulitis who underwent colectomy. Patients identifiable by ethnicity in the Nationwide Inpatient Sample with diverticulitis and colectomy between 2004 and 2010 were included. Univariate comparisons were made between Asian and non-Asian patients by using t tests for continuous variables and χ tests for categorical variables. Propensity score matching analysis was performed to compare Asian patients with otherwise similar non-Asian patients. Included were 58,142 non-Asian and 335 Asian patients with diverticulitis who underwent a colectomy. The primary outcomes were in-hospital mortality, hospital length of stay, and total costs. Asian patients were younger (56.1 vs. 59.2 years, p < 0.0001), were more likely to undergo a right colectomy (22.7% vs. 4.1%, p < 0.0001), and were more likely to have emergent/urgent surgery than the non-Asian patients (67.1% vs. 49.8%, p < 0.0001). Without controlling for patient/disease factors, there were statistically significant differences in mortality (non-Asian 2.2% vs. Asian 4.2%; p = 0.014), length of stay (non-Asian 8.9 vs. Asian 9.8 days; p = 0.0166), and costs (non-Asian $18,783 vs. Asian $21,901; p = 0.001). Propensity score matching comparing 333 non-Asian patients with 333 similar Asian patients showed that, whereas differences in cost and length of stay became insignificant, the difference in mortality remained statistically significant. The ethnicity variable was not uniformly collected by all states within the Nationwide Inpatient Sample database. Among patients undergoing a colectomy for diverticulitis, a higher mortality was observed in Asian patients and right-sided disease. Future longitudinal studies comparing the natural history and outcomes of management between right- and left-sided diverticulitis are necessary to investigate whether a true ethnic disparity exists.

Disease Course of Right- and Left-sided Diverticulitis in a Western Population

Aim: To evaluate the similarities and differences in disease courses between right- and left-sided diverticulitis in a Western population. Methods: All consecutive patients admitted in a Dutch regional hospital between 2004 and 2008 for conservative or operative management of clinically and radiologically confirmed acute right- and left-sided diverticulitis were analyzed retrospectively. Diverticulitis was clinically suspect if the patient presented with lower abdominal pain combined with at least one elevated inflammatory parameter (temperature, WBC, CRP or ESR). Diverticulitis was radiologically confirmed if at least US or CT demonstrated signs of acute right- or left-sided diverticulitis. Differences in incidence, patient characteristics, clinical presentation and disease course between the two diagnoses were analyzed. Results: The hospital system yielded 425 patients with a diverticulosis/diverticulitis discharge coding. 57% was excluded because these patients had another diagnosis demonstrated by imaging, besides diverticulosis (19%), had no imaging at all (16%), were elective or referred (7%), were not admitted (4%) or had other reasons (11%). A total of 183 admitted patients with both clinical and radiological confirmed acute colonic diverticulitis were included. The incidence of right-sided diverticulitis was 8%. Patients with right-sided diverticulitis were predominantly female (86% compared to 47% in leftsided diverticulitis, P = 0.05). Median CRP at presentation was lower in right sided diverticulitis, 30 compared to 71 mg/L (P = 0.001). No other differences in clinical presentation, like the severity of diverticulitis, and disease course, like the need for acute surgery, were found between right and left-sided diverticulitis. Conclusions: Disease course of acute right-sided diverticulitis in Caucasians is comparable to left-sided diverticulitis. Left-sided diverticulitis treatment guidelines may also apply for the right-sided diverticulitis in Caucasians.

Management of Colonic Diverticulitis Tailored to Location and Severity: Comparison of the Right and the Left Colon.

PurposeThis study assessed optimal management of colonic diverticulitis as functions of disease location and severity and factors associated with complicated diverticulitis.MethodsThis retrospective review analyzed 202 patients diagnosed between 2007 and 2014 at Chonbuk National University Hospital, South Korea, with colonic diverticulitis by using abdominopelvic computed tomography. Diverticulitis location was determined, and disease severity was categorized using the modified Hinchey classification.ResultsPatients included 108 males (53.5%) and 94 females (46.5%); of these, 167 patients (82.7%) were diagnosed with right-sided and 35 (17.3%) with left-sided colonic diverticulitis. Of the 167 patients with right-sided colonic diverticulitis, 12 (7.2%) had complicated and 155 (92.8%) had uncomplicated diverticulitis; of these, 157 patients (94.0%) were successfully managed conservatively. Of the 35 patients with left-sided colonic diverticulitis, 23 (65.7%) had complicated and 12 (34.3%) had uncomplicated diverticulitis; of these, 23 patients (65.7%) were managed surgically. Among patients with right-sided diverticulitis, those with complicated disease were significantly older (54.3 ± 12.7 years vs. 42.5 ± 13.4 years, P = 0.004) and more likely to be smokers (66.7% vs. 32.9%, P = 0.027) than those with uncomplicated disease. However, among patients with left-sided diverticulitis, those with complicated disease had significantly lower body mass index (BMI; 21.9 ± 4.7 kg/m2 vs. 25.8 ± 4.3 kg/m2, P = 0.021) than those with uncomplicated disease.ConclusionConservative management may be effective in patients with right-sided diverticulitis and patients with uncomplicated left-sided colonic diverticulitis. Surgical management may be required for patients with complicated left-sided diverticulitis. Factors associated with complicated diverticulitis include older age, smoking and lower BMI.

Is surgery necessary to confirm diagnosis of right-sided diverticulitis in spite of relevant clinical and radiological findings?

Diverticulosis of the right colon is an uncommon entity. Aim of the present study was to report outcome in patients with right-sided diverticulitis diagnosed using computed tomography (CT) and treated conservatively. Twelve patients with clinical and radiological diagnosis of cecal or right-sided diverticulitis who were treated conservatively between February 2013 and December 2014 were included. Demographic and clinical data were retrospectively analyzed. Female to male ratio was 1:1 with mean age of 45.08±14.4 years. Mean length of symptom history before admission was 2.08±1.3 days. Most common presenting symptom was right lower abdominal pain, seen in 72.7% of the patients. Abdominal ultrasound alone was performed for 10 patients, and 2 also had abdominal CT. Mean duration of hospitalization was 2.8±1.5 days. All patients were successfully treated with medical therapy. There was no recurrence during mean follow-up period of 8.2±5.6 months. If uncomplicated diverticulitis of the right colon is correctly diagnosed with radiological evaluation, antibiotic therapy and bowel rest should be considered as treatment modality, as there was no recurrence observed in short-term follow-up period and this option presents advantage of avoiding surgical intervention.

There Is No Role for Colonoscopy after Diverticulitis among Asian Patients Less than 50 Years of Age

Background: Colonoscopy is advocated following acute diverticulitis to ensure that malignancy is not missed. In an Asian population, diverticulitis is more common in the right colon and in younger patients. The purpose of this study is to examine the utility of colonoscopy amongst Asian patients <50 years of age who have had colonic diverticulitis. Methods: A retrospective review of all patients aged 50 years and under who were treated for colonic diverticulitis between 2012 and 2014 was performed. All patients were advised to undergo a colonoscopy when the diverticulitis had settled, and findings at colonoscopy were recorded. Results: Fifty-five patients aged <50 years had acute diverticulitis. Forty-eight (87.3%) had right-sided diverticulitis. Amongst them, 45 (93.8%) had Hinchey 1a, 1b or 2 diverticulitis, while none had Hinchey 4 diverticulitis. Excluding the only patient that underwent a colonic resection, 27 (50.0%) patients returned for a colonoscopy. None of these patients were found to have colorectal cancer or an advanced adenoma. Six (11.1%) of them had adenomas with low-grade dysplasia. Conclusion: Right-sided diverticulitis is more common in the young Asian population. Most patients can be conservatively treated. Follow-up colonoscopy may not be required in these patients.

Right-sided diverticulitis: An unusual presentation of abdominal pain in children

Acute diverticulitis is a rare and dangerous condition in a pediatric patient. The clinical presentation of right-sided diverticulitis mimics acute appendicitis. Hence, understanding the clinical presentation and treatment of right-sided diverticulitis is important. We report a case of right-sided diverticulitis in a 12-year-old girl and discuss the presentation and diagnosis of this disease.

Gossypiboma Presenting as Coloduodenal Fistula – Report of a Rare Case With Review of Literature

The term gossypiboma is used to describe a mass of cotton matrix left behind in a body cavity intraoperatively. The most common site reported is the abdominal cavity. It can present with abscess, intestinal obstruction, malabsorption, gastrointestinal hemorrhage, and fistulas. A 37-year-old woman presented with pain in the right hypochondrium for 2 months following open cholecystectomy. As she did not improve with proton pump inhibitors, an esophagogastroduodenoscopy (EGD) was done, which showed a possible gauze piece stained with bile in the first part of the duodenum. Contrast-enhanced computed tomography (CECT) of the abdomen revealed an abnormal fistulous communication of the first part of duodenum with proximal transverse colon, with a hypodense, mottled lesion within the lumen of the proximal transverse colon plugging the fistula, suggestive of a gossypiboma. Excision of the coloduodenal fistula, primary duodenal repair, and feeding jejunostomy was done. The patient recovered well and is now tolerating normal diet. Coloduodenal fistula is usually caused by Crohn's disease, malignancy, right-sided diverticulitis, and gall stone disease. Isolated coloduodenal fistula due to gossypiboma has not been reported in the literature so far to the best of our knowledge. We report this case of coloduodenal fistula secondary to gossypiboma for its rarity and diagnostic challenge.

Outpatient treatment for acute uncomplicated diverticulitis

Traditionally, treatment of acute diverticulitis has mostly been based on inpatient care. The question arises whether these patients can be treated on an outpatient basis as the admissions for diverticular disease have been shown to be increasing every year. We studied whether outpatient treatment of acute uncomplicated diverticulitis is feasible and safe, and which patients could benefit from outpatient care. A retrospective cohort study was carried out in two teaching hospitals using hospital registry codes for diverticulitis. All patients diagnosed with acute uncomplicated diverticulitis between January 2004 and January 2012, confirmed by imaging or colonoscopy, were included. Exclusion criteria were patients with recurrent diverticulitis, complicated diverticulitis (Hinchey stages 2, 3, and 4), and right-sided diverticulitis. Inpatient care was compared with outpatient care. Primary outcome was admission for outpatient care and the complication rate in both groups. Multivariate analysis was carried out to identify potential factors for inpatient care. Of 627 patients with diverticulitis, a total of 312 consecutive patients were identified with primary uncomplicated diverticulitis of the sigmoid colon; 194 patients had been treated as inpatients and 118 patients primarily as outpatients. In this last group, 91.5% had been treated successfully without diverticulitis-related complications or the need for hospital admission during a mean follow-up period of 48 months. Despite inherent patient selection in a retrospective cohort, ambulatory treatment of patients presenting with uncomplicated acute diverticulitis seems feasible and safe. In mildly ill and younger patients, hospital admission can be avoided.

Colonic diverticulitis in young Asians: a predominantly mild and right‐sided disease

The management of diverticulitis in young Asian patients remains challenging. This study aimed to highlight the issues of managing diverticulitis in young Asians. A retrospective review of all patients who were admitted for acute colonic diverticulitis from October 2003 to December 2008 was performed. Patients who were ≤50 year old were considered 'young' and formed the study group. The study group consisted of 142 patients. The majority (n = 126, 88.7%) had right-sided diverticulitis and most (n = 117, 82.4%) were mild in severity. Most of the patients who underwent emergency surgery were for suspected appendicitis (39/56, 69.6%). When we compared between those aged ≤50 and >50 years, the older group had worse diverticulitis (odds ratio (OR), 4.90, 95% confidence interval (CI), 2.00-11.99), been operated for indications other than suspected appendicitis (OR, 13.08, 95% CI, 5.42-31.56) and undergone a colectomy (OR, 9.96, 95% CI, 4.12-24.10). The younger group had a much higher incidence of right-sided disease (OR: 7.80, 95% CI: 4.32-14.07). Over a median follow-up of 40 (6-90) months, 7 (4.9%) patients were readmitted for a total of eight times for recurrent attacks of diverticulitis and all were successfully treated conservatively. Five other patients underwent elective surgery for persistent symptoms. Diverticulitis in young Asians is often right-sided and mild in severity. A significant proportion is only diagnosed when operated for presumed appendicitis. Recurrent attacks are uncommon and can often be treated non-surgically.

Diagnosis and Treatment of Colon Diverticulitis

Colonic diverticular disease is the common conditions in industrialized and westernized countries, but it is relatively rare in areas such as Asia. Colonic diverticula are asymptomatic in most cases, only 10-25% develop diverticulitis and 1% finally gets surgery. The location of colonic diverticulitis are significantly different in Western countries and Asia. Left-sided diverticulitis is common in Western countries, while in Asians, right-sided diverticulitis is more prevalent. A CT scans is commonly used to diagnose diverticulitis and its complication such as abscess, obstruction, fistula and perforation. It also has been used in percutaneous drainage of diverticular abscess and predicting the success of medical therapy. After resolution of clinical attack of diverticulitis, colonoscopy can be performed to exclude colon cancer. The current therapeutic approaches for colonic diverticulitis are relieving symptoms and preventing complications. Uncomplicated diverticulitis is successfully treated with antibiotics, bowel rest and pain control, while complicated diverticulitis require surgical consultation. Treatment strategy of recurrent diverticulitis depends on age and comorbid diseases as well as the frequency and severity of subsequent attacks. (Korean J Med 2013;85:563-570)

Non-operative treatment of right-sided colonic diverticulitis has good long-term outcome: a review of 226 patients

Data highlighting the long-term outcome following an initial episode of right-sided colonic diverticulitis is lacking. This study aims to evaluate and follow up on all patients with right-sided colonic diverticulitis. A retrospective review of all patients who were discharged with a diagnosis of right-sided colonic diverticulitis from January 2003 to April 2008 was performed. A total of 226 patients, with a median age of 49 (range, 16-93) years, were admitted for acute right-sided colonic diverticulitis. The majority of the patients (n = 198, 87.6%) had mild diverticulitis (Hinchey Ia and Ib). Seventy-three (32.3%) patients underwent emergency surgery. The indications of surgery were predominantly suspected appendicitis (n = 50, 22.1%) and perforated diverticulitis (n = 16, 7.1%). Right hemicolectomy was performed in 32 (43.8%) patients, while appendectomy, with or without diverticulectomy, was performed in the rest (n = 41, 56.2%). There were seven patients who underwent elective right hemicolectomy after their acute admissions.Over a median duration of 64 (12-95) months, there were only nine patients who were readmitted 12 times for recurrent diverticulitis at a median duration of 17 (1-48) months from the index admission. The freedom from failure (recurrent attacks or definitive surgery (right hemicolectomy)) at 60months was 92.0% (95% Confidence interval 86.1%-97.9%). Right-sided diverticulitis is commonly encountered in the Asian population and often gets misdiagnosed as acute appendicitis. If successfully managed conservatively, the long-term outcome is excellent.

Conservative treatment of right-sided colonic diverticulitis

Diverticulosis of the right colon occurs in a small percentage of patients in Western countries. Clinical presentation of right-sided colon diverticulitis is indistinguishable from that of acute appendicitis, and the majority of patients undergo surgical intervention for presumed appendicitis. The liberal use of diagnostic radiological modalities whenever appendicitis was suspected led to correct diagnosis and also to more preoperative diagnosis of right-sided diverticulitis, which consented conservative medical therapy in cases of uncomplicated right-sided diverticulitis. The aim of the study was to report the outcome in patients with right-sided diverticulitis diagnosed nonoperatively using computed tomography scanning and treated conservatively. Patients with clinical and radiological diagnosis of cecal or right colon diverticulitis treated conservatively between January 2005 and December 2007 were included. The demographic and clinical data were retrospectively analyzed. Fifteen patients were included in this study. The median age was 52 years (range, 34-72 years) and the duration of symptoms was 4 days (range, 1-9 days) before the diagnosis. The median hospital stay was 5 days (range, 1-9 days). All patients were successfully treated with medical therapy. During a median follow-up of 32 months (range, 24-52 months) only one patient (6.6%) had a recurrent attack, and he was successfully treated again with medical therapy. The routine use of the computed tomography scan for abdominal pain in the right lower quadrant, and whenever right-sided diverticulitis is suspected, improves diagnosis and reduces surgical interventions. The current study provides additional data in support of conservative therapy as the initial treatment in acute right-sided diverticulitis, even in cases of recurrence.

Acute right‐sided colonic diverticulitis mimicking appendicitis: A report of two cases

We describe two right-sided diverticulitis cases that presented with marked right iliac fossa tenderness with guarding and rebound and laboratory parameters resembling acute appendicitis. The imaging findings suggested diverticulitis in both cases. One of the patients underwent surgery and the other one was followed up with medical treatment. Awareness of these imaging findings may aid in the diagnosis of right-sided diverticulitis, which is frequently misdiagnosed and mistreated.

Surgical treatment of complicated right colonic diverticulitis: laparoscopic versus open surgery

Complicated right colonic diverticulitis is more common in Eastern countries. Although this disease entity is treated primarily with surgery, it is uncertain whether the outcomes of laparoscopic treatment also are comparable with those of open surgery. This study aimed to evaluate the outcome for laparoscopic surgical management of complicated right-sided colonic diverticulitis compared with that for open surgery. Between 1999 and 2011, 59 patients who underwent extensive surgery for complicated right colonic diverticulitis were enrolled from two hospitals. All the patients were suspected of having a large abscess or perforation with peritonitis symptoms preoperatively. Laparoscopic surgery was performed for 28 consecutive patients in the one hospital, and open surgery was performed for 31 consecutive patients in the other hospital. There was no conversion in the laparoscopic surgery cases. Clinical outcomes were analyzed and compared between the two groups. Laparoscopic surgery had a longer operating time (165 min) than open surgery (132 min) (p = 0.003). The two groups did not differ significantly in terms of postoperative hospital stay (laparoscopy 9.8 ± 2.7 days versus open surgery 12.8 ± 8.8 days; p = 0.234) or resumption of diet (laparoscopy 5.5 ± 2.4 days versus open surgery 6.3 ± 3.0 days; p = 0.286). Five patients in the laparoscopy group (17.8 %) had complications such as ileus, abscess, and bleeding, one of whom was treated with surgery. Nine patients in the open surgery group (29 %) had complications, two of whom were treated with surgery. The laparoscopic approach to complicated right colonic diverticulitis may be feasible. The clinical outcomes were comparable with those for open surgery.

Su1511 Right Sided Diverticulitis (RSD) - Highly Successful Non-Operative Management and Low Recurrence Rate

Introduction: Preoperative localisation of tumour is an essential requirement in Laparoscopic colorectal surgery. Tattooing guidelines should be simple to follow and consistent for all lesions irrespective of the location of the tumour. Our recommendations were: To place at least two spots of tattoo distal to each lesion, and clearly document site of tattoo with respect to tumour in the endoscopy report. Method: We conducted a prospective audit of endoscopic tattooing of colorectal tumours resected in our hospital from February 2010 to January 2011. It was felt that the current guidelines were too complicated, leading to higher rates of inaccurate tattooing. Thereafter new guidelines were developed and subsequent practice reaudited. Results: 2010: 37 patients in total were identified. 14 were not tattooed. 3 patients had a tattoo which was inaccurate. 13 had accurate and well documented tattoos. 7 patients had tattoos of unknown accuracy. 2011: 24 patients in total were identified. 6 patients were not tattooed. 4 patients had no tattoos visible at operation. 1 patient had a tattoo which was inaccurate. 11 patients had accurate and well documented tattoos. 2 patients had tattoos of unknown accuracy. Of those patients which were tattooed and seen at surgery, 78.6% were accurate and clearly documented in 2011 compared to 56.5% in 2010 (p=0.2124) Of those patients which were tattooed and seen at surgery, 14.2% had unknown accuracy (not clearly documented) in 2011, compared to 30.4% in 2010 (p=0.3032) Of those patients which were tattooed and seen at surgery 7.14% were deemed inaccurate (tattoo in wrong place) in 2011, compared to 13.04% in 2010 (p=0.6043). Conclusion: The simpler method of tattooing all tumours distally has improved the accuracy of tattooing.

The Clinical Factors for Predicting Severe Diverticulitis in Korea: A Comparison with Western Countries

Background/AimsIt is unclear whether the risk factors associated with complicated diverticulitis in Asian and Western countries are the same. We evaluated the risk factors associated with severe diverticulitis (SD) in Korea and compared the clinical characteristics of diverticulitis according to location.MethodsA retrospective review of 190 patients hospitalized with acute diverticulitis from January 2005 to June 2010 was conducted. SD was defined as one of the following: perforation, abscess, obstruction, sepsis, or peritonitis that required an urgent operation.ResultsTwenty-four patients (12.6%) were diagnosed with SD. SD was significantly associated with older age, a fever over 38℃, changes in bowel habits and a high visceral adipose tissue (VAT)/total adipose tissue (TAT) ratio. Multivariate analysis showed that the risk factors for developing SD were an age of 40 years or more (odds ratio [OR], 3.2; p=0.032), male gender (OR, 4.0; p=0.021) and left-sided diverticulitis (OR, 6.2; p=0.017). Right-sided diverticulitis (n=175, 92.1%) was significantly associated with younger ages, fewer changes in bowel habits, fewer comorbidities and non-SD.ConclusionsThis study suggests that the risk factors for developing SD in Korea, where right-sided diverticulitis is predominant, are the male gender, an age of more than 40 years old, and left-sided diverticulitis. Given that there are different risk factors for developing SD in Western countries, different strategies for the treatment of diverticulitis in the Korean population seem to be needed.

Cecal diverticulitis as a continuing diagnostic and management dilemma: a report of two cases in children

Right-sided diverticulitis remains an exceedingly rare condition in the pediatric population. The clinical presentation mimics acute appendicitis, and the correct diagnosis is often difficult to make prior to operative exploration. We report two cases of cecal diverticulitis, and discuss the diagnosis and management of this disease, with a review of the literature.

Right-sided Diverticulitis Mimics Appendicitis

BackgroundRight-sided diverticulitis is a rare source of right lower quadrant pain in Western society; however, it is quite common in Asian societies. Right-sided diverticulitis presents very similarly to appendicitis, with right lower quadrant pain, fever, nausea, and laboratory abnormalities, and is often seen in young patients. ObjectivesIn this report, we present a case of right-sided diverticulitis. We review right-sided diverticulitis’ diagnosis and management. It is important to diagnose right-sided diverticulitis because it is a good mimic of appendicitis and ideally should be diagnosed before a patient has unnecessary surgery. Case ReportA 26-year-old Asian woman presented for evaluation of right lower quadrant pain and fever. She was initially thought to have appendicitis clinically, but had right-sided diverticulitis diagnosed by computed tomography (CT) scan. She was admitted and received intravenous antibiotics and bowel rest. Her right-sided diverticulitis resolved in 3 days. ConclusionsSevere right lower quadrant pain in young patients of Asian descent can be right-sided diverticulitis. Right-sided diverticulitis is a benign condition managed medically that mimics appendicitis. CT imaging seems to be the best way to avoid unnecessary surgery.

Laparoscopic one-stage resection of right and left colon complicated diverticulitis equivalent to hinchey stage I–II

The safety and effectiveness of laparoscopic surgery is well established for recurrent, uncomplicated diverticular disease, but not for complicated diverticular disease. Using the Hinchey classification, we compared laparoscopic colon resection (LAPH) with conventional open colon resection (OPH) for the treatment of complicated diverticulitis equivalent to Hinchey stage I-II. In this study, the Hinchey classification (I-IV) was also adopted for right-sided diverticulitis (I'-IV'). We reviewed the clinical records of 58 patients who underwent colon resection for complicated colon diverticulitis (Hinchey stage I-IV or I'-IV') between May 1994 and December 2008. Fifty-two patients underwent colon resection for Hinchey I-II or I'-II' disease; as LAPH in 36 and as OPH in 16. Only one patient required conversion to the open procedure after laparoscopy. The overall complication rate was significantly higher in the OPH group (43.8%) than in the LAPH group (16.7%; P < 0.05). Wound infection was significantly more common in the OPH group (37.5%) than in the LAPH group (11.1%; P < 0.05). Hospital stay was significantly shorter in the LAPH group (P < 0.05). Hartmann procedure was performed in one patient from each group. No anastomotic leakage occurred in either group. Our findings indicate that laparoscopic surgery can be performed safely and effectively even for patients with Hinchey I-II, I'-II' colonic diverticulitis.