Laparoscopy for Diverticular Disease

Douglas K. Rex, MD

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In This Article

Abstract and Introduction

Abstract

Laparoscopy led to fewer postoperative complications than did open surgery.

Introduction

Laparoscopic colectomy for elective surgical treatment of diverticulitis is not as widely accepted as laparoscopic resection for colorectal cancer and endoscopically unresectable colorectal polyps. Also, conversion rates from laparoscopic to open resection are considerably higher for diverticular disease than for neoplasia. However, several trials have indicated that a laparoscopic approach to diverticular disease results in less morbidity than an open-surgery approach.

To examine this issue further, investigators evaluated data from the American College of Surgeons National Surgical Quality Improvement Program, a prospective database collected from 120 private and academic hospitals during a 4-year period. The current nonrandomized study compared outcomes in 6970 patients who underwent surgery for diverticular disease, of whom 3468 underwent open procedures and 3502 underwent laparoscopic procedures. (Of note, the frequency of true laparoscopic approaches vs. hybrid approaches — such as those involving the use of a hand port — was unclear.) Compared with patients who underwent open surgery, those who underwent laparoscopic surgery were younger and had lower body-mass indexes, fewer comorbidities, lower anesthesiology risk, and lower probability of complications. The authors used a propensity score analysis to adjust for selection bias and for the study's nonrandomized design.

Multivariate logistic regression analysis revealed that, compared with open surgery, laparoscopic procedures resulted in approximately 50% reductions in both superficial- and deep-incision infections, a 34% reduction in sepsis, and a 66% reduction in septic shock. Factors associated with increased risk for complications included chronic obstructive pulmonary disease, higher anesthesiology risk, and obesity.

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