Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.
Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy.
Tech Coloproctol. 2018 Sep;22(9):657-662. doi: 10.1007/s10151-018-1843-9. Epub 2018 Sep 15.
Laparoscopic sigmoidectomy is the gold standard for elective surgical treatment of diverticulitis. A periumbilical single-port technique reduces the size of the access wound, usually to 3-4 cm. However, in the presence of large phlegmon or fistulae, the risk of conversion is higher and the extraction site might be enlarged. A suprapubic Pfannenstiel incision reduces the risk of incisional hernia compared to umbilical access and might provide the possibility to perform sigmoidectomy with a hybrid technique. The aim of the present study was to investigate the feasibility of laparoscopic sigmoidectomy through a single suprapubic transverse access for large diverticular phlegmon.
Consecutive patients with a diverticular inflammatory mass ≥ 5 cm, with or without sigmoid-vesical fistula, were considered candidates for laparoscopic sigmoidectomy through a 5-cm single-port suprapubic (SPSP) access, extended (if required) to match the size of the inflammatory mass.
Twenty patients underwent SPSP sigmoidectomy at our institution in April 2014-April 2017. All procedures were completed by SPSP access, with no intraoperative complications or need for additional trocar placement. Eight patients had a sigmoid-vesical fistula (bladder sutured in three patients). The splenic flexure was mobilized in nine patients. Median operative time was 178 min and median hospital stay was 5.5 days (iqr 4-6). Postoperative complications occurred in four patients and included one subcutaneous hematoma, one urinary tract infection, and two superficial wound infections. After a median follow-up time of 25 months (interquartile range 15-38), all patients experienced complete resolution of symptoms, with no incisional hernias reported.
SPSP sigmoidectomy for diverticulitis is feasible and effective, minimizing the size of the access wound and avoiding increased risk of hernia. This approach might be especially valuable for the management of large diverticular phlegmon and sigmoid-vesical fistula.
腹腔镜乙状结肠切除术是憩室炎择期手术治疗的金标准。经脐单孔技术可减小手术切口的大小，通常为 3-4cm。然而，在存在大的脓性肿块或瘘管时，中转开腹的风险更高，且取出部位可能会扩大。耻骨上的 Pfannenstiel 切口与脐部入路相比，疝的发生率较低，并且可能有行杂交技术行乙状结肠切除术的可能。本研究旨在探讨经脐上单孔耻骨上横切口行腹腔镜乙状结肠切除术治疗大的憩室炎脓性肿块的可行性。
连续患有≥5cm 的憩室炎炎性肿块的患者，无论是否存在乙状结肠-膀胱瘘，都被认为是通过 5cm 经脐上单孔耻骨上（SPSP）入路行腹腔镜乙状结肠切除术的候选者，可根据炎症肿块的大小进行扩展。
2014 年 4 月至 2017 年 4 月，我院共 20 例患者行经 SPSP 乙状结肠切除术。所有手术均通过 SPSP 入路完成，无术中并发症或需要额外的套管针放置。8 例患者有乙状结肠-膀胱瘘（3 例患者行膀胱缝合）。9 例患者行脾曲游离。中位手术时间为 178 分钟，中位住院时间为 5.5 天（四分位距 4-6）。术后并发症 4 例，包括皮下血肿 1 例、尿路感染 1 例、浅表伤口感染 2 例。中位随访时间为 25 个月（四分位距 15-38），所有患者均完全缓解症状，无切口疝发生。
经 SPSP 乙状结肠切除术治疗憩室炎是可行且有效的，可最大限度地减小手术切口的大小，避免疝的风险增加。对于大的憩室炎脓性肿块和乙状结肠-膀胱瘘的处理，这种方法可能特别有价值。
