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.
Intraoperative 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 89-111.6
cc, mean time till lst mobilization and till have audible intestinal sounds
was 13.2±3.1 and 2.6±0.7 days, respectively. Mean time till lm oral intake
was 3.2±0.8 days and length of hospital stay was 6.211.2 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
diversion 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. |
