Abbass Mohammad A, Tsay Anna T, Abbas Maher A
Department of Surgery, Kaiser Permanente, Los Angeles, CA, USA.
Chair, Minimally Invasive and Robotic Surgery, 4760 Sunset Boulevard, Third Floor, Los Angeles, CA 90027, USA.
JSLS. 2013 Oct-Dec;17(4):636-40. doi: 10.4293/108680813X13693422520512.
A growing number of operations for sigmoid diverticulitis are being done laparoscopically. There is a paucity of data on the outcome of laparoscopy for sigmoid diverticulitis complicated by colonic fistula. The aim of this study was to compare the results of laparoscopic resection of sigmoid diverticulitis with and without colonic fistula.
A retrospective review was conducted of all patients who underwent laparoscopic resection of sigmoid diverticulitis complicated by fistula at a single tertiary care institution over a 7-year period. Comparison was made with a group of patients who underwent resection for diverticulitis without fistula during the same study period.
Forty-two patients were analyzed (group 1: diverticular fistula, group 2: no fistula). The median age was similar (49 vs. 50 years, P = .68). A chronic abscess was present in 24% of patients in group 1 and 10% in group 2 (P = .40). Fistula types were colovesical (71%), colovaginal (19%), and colocutaneous (10%). Operation types were sigmoidectomy (57% vs. 81%) and anterior resection (43% vs. 19%) in groups 1 and 2, respectively (P = .18). Ureteral catheters were used more frequently in group 1 (67% vs. 33% [P = .06]). No difference was noted in operative time, blood loss, conversion rate, length of stay, overall complications, wound infection rate, readmission rate, reoperation rate, and mortality. All patients healed without fistula recurrence.
Patients with sigmoid diverticulitis with fistula can be successfully treated with laparoscopic excision, with similar outcomes for patients without fistula.
越来越多的乙状结肠憩室炎手术通过腹腔镜进行。关于腹腔镜治疗合并结肠瘘的乙状结肠憩室炎的结果的数据较少。本研究的目的是比较有和没有结肠瘘的乙状结肠憩室炎腹腔镜切除术的结果。
对一家三级医疗机构在7年期间接受腹腔镜切除合并瘘管的乙状结肠憩室炎的所有患者进行回顾性研究。与同一研究期间接受无瘘管憩室炎切除术的一组患者进行比较。
分析了42例患者（第1组：憩室瘘管，第2组：无瘘管）。中位年龄相似（49岁对50岁，P = 0.68）。第1组24%的患者和第2组10%的患者存在慢性脓肿（P = 0.40）。瘘管类型为结肠膀胱瘘（71%）、结肠阴道瘘（19%）和结肠皮肤瘘（10%）。第1组和第2组的手术类型分别为乙状结肠切除术（57%对81%）和前切除术（43%对19%）（P = 0.18）。第1组更频繁地使用输尿管导管（67%对33% [P = 0.06]）。在手术时间、失血量、转换率、住院时间、总体并发症、伤口感染率、再入院率、再次手术率和死亡率方面未发现差异。所有患者均愈合且无瘘管复发。
合并瘘管的乙状结肠憩室炎患者可通过腹腔镜切除成功治疗，无瘘管患者的结果相似。
