Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany,
J Gastrointest Surg. 2013 Nov;17(11):1966-71. doi: 10.1007/s11605-013-2296-0. Epub 2013 Aug 6.
Surgical treatment of acute complicated sigmoid diverticulitis is still under debate while elective treatment of recurrent diverticulitis has proven benefits. The aim of this study was to evaluate the clinical and histological outcome of acute and elective laparoscopic sigmoid colectomy in patients with diverticulitis.
A retrospective review was conducted where 197 patients were analyzed undergoing laparoscopic sigmoid resection for acute complicated diverticulitis and recurrent diverticulitis. Single-stage laparoscopic resection and primary anastomosis were routinely performed using a 3-trocar technique. Recorded data included age, sex, American Society of Anesthesiologists (ASA)-score, operative time, duration of hospital stay, complications, and histological results.
Ninety-one patients received laparoscopy for acute diverticular disease (group I) and 93 patients underwent elective laparoscopic sigmoid resection for diverticulitis (group II). M/F ratio was 49:42 for group I and 37:56 for group II. Mean operative time and hospital stay was similar in both groups. Majority of patients were ASA II in both groups. Rate of minor complications was 14.3 % in group I and 7.5 % in group II. Major complications were 2.2 % for acute treatment and 4.3 % for elective resections. No anastomotic leakage and no mortality occurred. In 32.3 % of the patients of elective group II, destruction of the colonic wall with pericolic abscess, fistulization, or fibrinoid purulent peritonitis were identified.
Laparoscopic surgery for acute diverticular disease is safe and effective. Continuing bowl inflammations in histological specimens justify sigmoid resection in elective patients, but more effective pre-operative parameters need to be found to identify patients that would benefit from surgery during the initial episode.
急性复杂乙状结肠憩室炎的手术治疗仍存在争议，而择期治疗复发性憩室炎已被证实具有益处。本研究旨在评估憩室炎患者急性和择期腹腔镜乙状结肠切除术的临床和组织学结果。
回顾性分析了 197 例行腹腔镜乙状结肠切除术治疗急性复杂憩室炎和复发性憩室炎的患者。常规采用三孔技术行一期腹腔镜切除和一期吻合。记录的数据包括年龄、性别、美国麻醉医师协会（ASA）评分、手术时间、住院时间、并发症和组织学结果。
91 例患者因急性憩室疾病接受腹腔镜手术（I 组），93 例患者因憩室炎行择期腹腔镜乙状结肠切除术（II 组）。I 组男女比例为 49:42，II 组为 37:56。两组的平均手术时间和住院时间相似。两组大多数患者的 ASA 评分为 II 级。I 组轻微并发症发生率为 14.3%，II 组为 7.5%。急性治疗的主要并发症发生率为 2.2%，择期切除的主要并发症发生率为 4.3%。无吻合口漏和死亡发生。在 II 组的 32.3%的择期患者中，发现结肠壁破坏伴结肠旁脓肿、瘘管形成或纤维蛋白脓性腹膜炎。
腹腔镜手术治疗急性憩室炎是安全有效的。组织学标本中持续的肠道炎症表明择期患者需要行乙状结肠切除术，但需要找到更有效的术前参数来识别在初次发作时受益于手术的患者。
