Feasibility and Outcome of Laparoscopic Management of Complicated Diverticulosis
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Objectives: To evaluate the surgical feasibility and short-term outcome of laparoscopic management of complicated cases of diverticular disease. Patients & Methods: The study included 12 patients; 9 males and 3 females with mean age of 57±5.8 years. All patients had preoperative colonoscopy and CT imaging to assure diagnosis. All patients had exploratory laparoscopy to either proceed or convert to open laparotomy and in all cases, a sigmoidectomy was performed with primary intracorporeal anastomosis using a circular end-to-end stapling device. Intrapperative data including duration of surgery, estimated blood loss, length of excised specimen, type and number of managed diverticular complications and number of cases converted to open surgery and time till first ambulation, time till first oral intake, length of hospital stay and postoperative morbidity and mortality were recorded. Results: Eight cases had successful laparoscopic management and 4 patients were converted to open surgery with a conversion rate of 33.3%. Exploratory laparoscopy detected variant pathologies in the same case; 7 patients had diverticular abscess that was drained with peritoneal lavage and primary colectomy with anastomosis was performed. Two cases had single colo-vesical fistula that, was closed with inverting burse-string suture, then colectomy was conducted successfully. Two females had colosalpingeal fistula; left salpingectomy was performed. Mean operative time was 180.6±32.9 minutes and mean operative blood loss was 89±11.6 cc, mean time till 1 mobilization and till have audible intestinal sounds was 13.2±3.1 and 2.6±0.7 days, respectively. Mean time till 1' oral intake was 3.2±0.8 days and length of hospital stay was 6.2±1.2 days. One patient required re-admission for signs of acute abdomen, clinical and CT examination revealed a localized left iliac fossa collection indicating anastomotic line leakage and patient had open peritoneal lavage and diversicm colostomy. Conclusion: Laparoscopic management of complicated diverticulitis is feasible and safe approach provided proper surgical decision was adequately ,taken concerning to proceed or not after laparoscopic exploration.