Laparoscopic vs. Open Colectomy for Sigmoid Diverticular Disease. 8 years of Minimally Invasive Colorectal Surgery at the Community Teaching Hospital
Dan Ruiz, M.D., Robert Shirinov, M.D., Howard Tiszenkel, M.D., James Turner, M.D., Amanda Bailey
Background: Surgery for diverticulitis can be a challenge due to significant inflammatory process in the surrounding area. Laparoscopic management of sigmoid diverticular disease has emerged as an important adjunct to the armamentarium of surgical options for this disease process. We compared laparoscopic colorectal resections to open surgery for left sided diverticular disease in a community teaching hospital.
Methods: After IRB approval, between July 1999 and January 2008, 66 cases of laparoscopic sigmoid colon resections (Group 1) and 65 cases of open resections (Group 2) for diverticular disease of the colon were reviewed and compared. This study represents a retrospective data analysis of patients' charts and medical records database, together with ongoing prospective review of eligible cases.
Results: Based upon the collected data, the mean age of Group 1 is 49 years of age (ranging from 20-60) and 65 for Group 2 (ranging from 32-85). In Group 1, there were 41 female and 25 male patients, with average ASA score of 2.1. In Group 2, there were 37 female and 28 male patients with average ASA score of 2. Postoperative length of stay (LOS), was significantly less in laparoscopic sigmoid colectomy patients 5.3 when compared to the open colectomy group 10. In Group 1, the mean length of stay was about 6.2 days, while in Group 2, it was about 14. There was a significantly shorter time to resume a diet for the laparoscopic group (approximately 2.3 compared to 5 for clear diets and 4.2 compared to 7.1 for regular diets in Groups 1 and 2 respectively). Group 1 had no mortalities; there were post op complications in 4 patients, and conversion to open surgery in 3 patients. In Group 2, there was a mortality of 4, and post op complications in 7 patients. Average operative time was 244 min. in laparoscopic group, compared to 219 min. in open group. Average estimated blood loss (EBL) during operation was 208 ml in group 1 and 378 ml in group 2.
Conclusion: Laparoscopic sigmoid colectomy as the modality of treatment for diverticular disease had better outcomes in respect to postoperative length of stay, mortality, and time to resume diet. Average operative time did not differ substantially in laparoscopic surgery compared to open and there was less blood loss during operation.
In addition, the outcomes for laparoscopic colorectal resections for left sided diverticular disease performed in a community hospital were similar to the historical results from academic health science centers.