Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina.
Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina.
Surg Endosc. 2020 Mar;34(3):1336-1342. doi: 10.1007/s00464-019-06910-y. Epub 2019 Jun 17.
Laparoscopic primary anastomosis (PA) without diversion for diverticulitis has historically been confined to the elective setting. Hartmann's procedure is associated with high morbidity rates that might be reduced with less invasive and one-step approaches. The aim of this study was to analyze the results of laparoscopic PA without diversion in Hinchey III perforated diverticulitis.
We performed a retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic sigmoidectomy for diverticular disease during the period 2000-2018. The sample was divided in two groups: elective laparoscopic sigmoid resection for recurrent diverticulitis (G1) and emergent laparoscopic sigmoidectomy for Hinchey III diverticulitis (G2). Demographics, operative variables, and postoperative outcomes were compared between groups.
A total of 415 patients underwent laparoscopic sigmoid resection for diverticular disease. PA without diversion was performed in 351 patients; 278 (79.2%) belonged to G1 (recurrent diverticulitis) and 73 (20.8%) to G2 (perforated diverticulitis). Median age, gender, and BMI score were similar in both groups. Patients with ASA III score were more frequent in G2 (p: 0.02). Conversion rate (G1: 4% vs. G2: 18%, p < 0.001), operative time (G1: 157 min vs. G2: 183 min, p < 0.001), and median length of hospital stay (G1: 3 days vs. G2: 5 days, p < 0.001) were significantly higher in G2. Overall postoperative morbidity (G1: 22.3% vs. G2: 28.7%, p = 0.27) and anastomotic leak rate (G1: 5.7% vs. G2: 5.4%, p = 0.92) were similar between groups. There was no mortality in G1 and one patient (1.3%) died in G2 (p = 0.21).
Laparoscopic sigmoid resection without diversion is feasible and safe in patients with perforated diverticulitis. In centers with vast experience in laparoscopic colorectal surgery, patients undergoing this procedure have similar morbidity and mortality to those undergoing elective sigmoidectomy.
腹腔镜原发性吻合术（PA）不进行分流术治疗憩室炎，历史上仅限于择期手术。Hartmann 手术与高发病率相关，而采用微创和一步法可以降低发病率。本研究的目的是分析腹腔镜 PA 不进行分流术治疗 Hinchey III 穿孔性憩室炎的结果。
我们对 2000 年至 2018 年期间所有接受腹腔镜乙状结肠切除术治疗憩室病的患者前瞻性收集数据库进行了回顾性分析。样本分为两组：因复发性憩室炎而接受择期腹腔镜乙状结肠切除术（G1）和因 Hinchey III 憩室炎而行紧急腹腔镜乙状结肠切除术（G2）。比较两组的人口统计学、手术变量和术后结果。
共有 415 例患者因憩室病接受腹腔镜乙状结肠切除术。351 例患者行 PA 不进行分流术；其中 278 例（79.2%）属于 G1（复发性憩室炎），73 例（20.8%）属于 G2（穿孔性憩室炎）。两组的中位年龄、性别和 BMI 评分相似。ASA III 评分的患者在 G2 中更为常见（p：0.02）。G2 的中转率（G1：4% vs. G2：18%，p<0.001）、手术时间（G1：157 分钟 vs. G2：183 分钟，p<0.001）和中位住院时间（G1：3 天 vs. G2：5 天，p<0.001）明显更高。两组的总体术后发病率（G1：22.3% vs. G2：28.7%，p=0.27）和吻合口漏发生率（G1：5.7% vs. G2：5.4%，p=0.92）相似。G1 中无死亡病例，G2 中有 1 例（1.3%）死亡（p=0.21）。
腹腔镜乙状结肠切除术后不进行分流术在穿孔性憩室炎患者中是可行且安全的。在腹腔镜结直肠手术经验丰富的中心，接受该手术的患者的发病率和死亡率与接受择期乙状结肠切除术的患者相似。
