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. 1998 Mar;227(3):335–342. doi: 10.1097/00000658-199803000-00004

Laparoscopically assisted anterior resection for diverticular disease: follow-up of 100 consecutive patients.

A R Stevenson 1, R W Stitz 1, J W Lumley 1, G A Fielding 1
PMCID: PMC1191270  PMID: 9527055

Abstract

PURPOSE: The objectives of this study were to refine the technique of laparoscopically assisted anterior resection (LAR) for diverticular disease and to analyze the morbidity and mortality rates, and longer term follow-up of the first 100 consecutive patients. METHODS: Data were collected prospectively, and follow-up was performed by an independent assessor using a standardized questionnaire. RESULTS: The median duration of surgery was 180 minutes, the median time for passage of flatus was 2 days after surgery, and the median length of hospital stay was 4 days. Overall, the morbidity rate was 21%, and the wound infection rate was 5%. There were no deaths. Eight patients underwent open laparotomy. The rate of complications was significantly greater in the latter group of patients (75%) than in those who underwent laparoscopy (16%, p = 0.002). The comparison between the first 20 cases and the last 20 patients revealed a significantly shorter duration of surgery (median 225 min. vs. 150 min.; p < 0.0001) and decreased length of stay (6 days vs. 4 days, p < 0.0001). Apart from a nonsignificant increase in the length of surgery, there were no differences in other study parameters when comparisons were made between those patients who underwent LAR for complicated diverticular disease and those patients who underwent uncomplicated diverticular disease. FOLLOW-UP: Ninety patients were available for follow-up at a median time of 37 months. Ninety-three percent of the patients reported that the surgery had improved their symptoms. No patient required hospitalization, and no one was treated with antibiotics for recurrent symptoms. CONCLUSION: Laparoscopically assisted anterior resection for diverticular disease has acceptable morbidity and mortality rates and a median postoperative hospital stay of only 4 days. Follow-up investigations revealed no recurrence of diverticulitis, and patients reported satisfaction regarding cosmetic and functional results.

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Selected References

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  1. Benn P. L., Wolff B. G., Ilstrup D. M. Level of anastomosis and recurrent colonic diverticulitis. Am J Surg. 1986 Feb;151(2):269–271. doi: 10.1016/0002-9610(86)90085-1. [DOI] [PubMed] [Google Scholar]
  2. Bennett C. L., Stryker S. J., Ferreira M. R., Adams J., Beart R. W., Jr The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg. 1997 Jan;132(1):41–45. doi: 10.1001/archsurg.1997.01430250043009. [DOI] [PubMed] [Google Scholar]
  3. Bruce C. J., Coller J. A., Murray J. J., Schoetz D. J., Jr, Roberts P. L., Rusin L. C. Laparoscopic resection for diverticular disease. Dis Colon Rectum. 1996 Oct;39(10 Suppl):S1–S6. doi: 10.1007/BF02053798. [DOI] [PubMed] [Google Scholar]
  4. Chodak G. W., Rangel D. M., Passaro E., Jr Colonic diverticulitis in patients under age 40: need for earlier diagnosis. Am J Surg. 1981 Jun;141(6):699–702. doi: 10.1016/0002-9610(81)90081-7. [DOI] [PubMed] [Google Scholar]
  5. Chodak G. W., Rangel D. M., Passaro E., Jr Colonic diverticulitis in patients under age 40: need for earlier diagnosis. Am J Surg. 1981 Jun;141(6):699–702. doi: 10.1016/0002-9610(81)90081-7. [DOI] [PubMed] [Google Scholar]
  6. Darzi A., Super P., Guillou P. J., Monson J. R. Laparoscopic sigmoid colectomy: total laparoscopic approach. Dis Colon Rectum. 1994 Mar;37(3):268–271. doi: 10.1007/BF02048165. [DOI] [PubMed] [Google Scholar]
  7. EGER E. I., 2nd, SAIDMAN L. J. HAZARDS OF NITROUS OXIDE ANESTHESIA IN BOWEL OBSTRUCTION AND PNEUMOTHORAX. Anesthesiology. 1965 Jan-Feb;26:61–66. doi: 10.1097/00000542-196501000-00011. [DOI] [PubMed] [Google Scholar]
  8. Erkola O. Nitrous oxide: laparoscopic surgery, bowel function, and PONV. Acta Anaesthesiol Scand. 1994 Nov;38(8):767–768. doi: 10.1111/j.1399-6576.1994.tb04000.x. [DOI] [PubMed] [Google Scholar]
  9. Falk P. M., Beart R. W., Jr, Wexner S. D., Thorson A. G., Jagelman D. G., Lavery I. C., Johansen O. B., Fitzgibbons R. J., Jr Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum. 1993 Jan;36(1):28–34. doi: 10.1007/BF02050298. [DOI] [PubMed] [Google Scholar]
  10. Farmakis N., Tudor R. G., Keighley M. R. The 5-year natural history of complicated diverticular disease. Br J Surg. 1994 May;81(5):733–735. doi: 10.1002/bjs.1800810538. [DOI] [PubMed] [Google Scholar]
  11. Franklin M. E., Jr, Rosenthal D., Abrego-Medina D., Dorman J. P., Glass J. L., Norem R., Diaz A. Prospective comparison of open vs. laparoscopic colon surgery for carcinoma. Five-year results. Dis Colon Rectum. 1996 Oct;39(10 Suppl):S35–S46. doi: 10.1007/BF02053804. [DOI] [PubMed] [Google Scholar]
  12. Griffen F. D., Knight C. D., Sr, Knight C. D., Jr Results of the double stapling procedure in pelvic surgery. World J Surg. 1992 Sep-Oct;16(5):866–871. doi: 10.1007/BF02066983. [DOI] [PubMed] [Google Scholar]
  13. Liberman M. A., Phillips E. H., Carroll B. J., Fallas M., Rosenthal R. Laparoscopic colectomy vs traditional colectomy for diverticulitis. Outcome and costs. Surg Endosc. 1996 Jan;10(1):15–18. doi: 10.1007/s004649910002. [DOI] [PubMed] [Google Scholar]
  14. Lumley J. W., Fielding G. A., Rhodes M., Nathanson L. K., Siu S., Stitz R. W. Laparoscopic-assisted colorectal surgery. Lessons learned from 240 consecutive patients. Dis Colon Rectum. 1996 Feb;39(2):155–159. doi: 10.1007/BF02068069. [DOI] [PubMed] [Google Scholar]
  15. McLeod R. S., Wright J. G., Solomon M. J., Hu X., Walters B. C., Lossing A. l. Randomized controlled trials in surgery: Issues and problems. Surgery. 1996 May;119(5):483–486. doi: 10.1016/s0039-6060(96)80254-6. [DOI] [PubMed] [Google Scholar]
  16. Munson K. D., Hensien M. A., Jacob L. N., Robinson A. M., Liston W. A. Diverticulitis. A comprehensive follow-up. Dis Colon Rectum. 1996 Mar;39(3):318–322. doi: 10.1007/BF02049475. [DOI] [PubMed] [Google Scholar]
  17. Parks T. G., Connell A. M. The outcome in 455 patients admitted for treatment of diverticular disease of the colon. Br J Surg. 1970 Oct;57(10):775–778. doi: 10.1002/bjs.1800571021. [DOI] [PubMed] [Google Scholar]
  18. Ramos J. M., Gupta S., Anthone G. J., Ortega A. E., Simons A. J., Beart R. W., Jr Laparoscopy and colon cancer. Is the port site at risk? A preliminary report. Arch Surg. 1994 Sep;129(9):897–900. doi: 10.1001/archsurg.1994.01420330011001. [DOI] [PubMed] [Google Scholar]
  19. Rhodes M., Rudd M., Nathanson L., Fielding G., Siu S., Hewett P., Stitz R. Laparoscopic anterior resection: a consecutive series of 84 patients. Surg Laparosc Endosc. 1996 Jun;6(3):213–217. [PubMed] [Google Scholar]
  20. Schauer P. R., Ramos R., Ghiatas A. A., Sirinek K. R. Virulent diverticular disease in young obese men. Am J Surg. 1992 Nov;164(5):443–448. doi: 10.1016/s0002-9610(05)81177-8. [DOI] [PubMed] [Google Scholar]
  21. Scheinin B., Lindgren L., Scheinin T. M. Peroperative nitrous oxide delays bowel function after colonic surgery. Br J Anaesth. 1990 Feb;64(2):154–158. doi: 10.1093/bja/64.2.154. [DOI] [PubMed] [Google Scholar]
  22. Stitz RW, Lumley JW. Laparoscopic Resection for Colorectal Cancer: An Australian Perspective. Semin Laparosc Surg. 1995 Dec;2(4):235–241. doi: 10.1053/SLAS00200235. [DOI] [PubMed] [Google Scholar]
  23. Tudor R. G., Farmakis N., Keighley M. R. National audit of complicated diverticular disease: analysis of index cases. Br J Surg. 1994 May;81(5):730–732. doi: 10.1002/bjs.1800810537. [DOI] [PubMed] [Google Scholar]
  24. WELCH C. E., ALLEN A. W., DONALDSON G. A. An appraisal of resection of the colon for diverticulitis of the sigmoid. Ann Surg. 1953 Sep;138(3):332–343. doi: 10.1097/00000658-195313830-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Wolff B. G., Ready R. L., MacCarty R. L., Dozois R. R., Beart R. W., Jr Influence of sigmoid resection on progression of diverticular disease of the colon. Dis Colon Rectum. 1984 Oct;27(10):645–647. doi: 10.1007/BF02553353. [DOI] [PubMed] [Google Scholar]

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