Abstract
PURPOSE: The feasibility of laparoscopic colectomy for colon surgery has now been well established. Most of the studies on laparoscopic colectomies include all types of colonic pathologies without discrimination. Our goal was to compare laparoscopic sigmoid colectomy vs. open sigmoid colectomy for simple sigmoid diverticular disease, to assess whether it can be done safely and whether the proposed advantages could be realized. METHODS: We evaluated the differences in outcomes of 66 laparoscopic sigmoid colectomy patients and 88 open sigmoid colectomy patients. We report a five-year outcomes analysis of 154 patients undergoing sigmoid colectomy for diverticular disease. We compared age, gender, history of prior abdominal surgery, estimated blood loss, operative time, total conversions with reason for conversion, time until a liquid diet was started, postoperative complications, hospital length of stay, operation costs, and total hospital charges incurred for both laparoscopic sigmoid colectomy and open sigmoid colectomy. RESULTS: Mean age and gender were similar in the two groups. However, the mean estimated blood loss (143 ml vs. 314 ml), time until a liquid diet was started (2.9 vs. 4.9 days), and hospital length of stay (4.8 vs. 8.8 days) were all significantly less in laparoscopic sigmoid colectomy patients. The mean operative time for laparoscopic sigmoid colectomy was 212 minutes as compared with 143 minutes for open sigmoid colectomy (P < 0.05). Conversion rate of laparoscopic sigmoid colectomy to open procedure was 19.7 percent. All laparoscopic sigmoid colectomy patients received a lighted ureteral stent preoperatively, which was removed at the end of surgery. Relevant complications for laparoscopic sigmoid colectomy vs. open sigmoid colectomy were as follows: anastomotic leak in 1 vs. 3 (1.5 vs. 3.4 percent) patients, hematuria in 64 vs. 6 (97 vs. 6.8 percent) patients, with an average duration for 2.93 vs. 3 days, urinary tract infection in 5 vs. 4 (7.6 vs. 4.5 percent) patients, and ureteral injury in 1 vs. 2 (1.5 vs. 2.2 percent) patients. Although the mean operating room charges were greater in the laparoscopic sigmoid colectomy patients ($9,566 vs. $7,306) the mean hospital charges ($13,953 vs. $14,863) were less. CONCLUSIONS: We recommend laparoscopic sigmoid colectomy as the modality of treatment for diverticular disease. Laparoscopic sigmoid colectomy seems to be a reliable, safe and efficacious treatment modality with better outcomes for diverticular disease of the sigmoid colon. The operative time for laparoscopic sigmoid colectomy is decreasing as surgeons gain more experience.
Similar content being viewed by others
References
D Redwine D Sharpe (1991) ArticleTitleLaparoscopic segmental resection of the sigmoid colon for endometriosis J Laparoendosc Surg 1 217–220 Occurrence Handle1:STN:280:By2D3szitFE%3D Occurrence Handle1834272
MA Liberman EH Phillips BJ Caroll M Fallas R Rosenthal (1996) ArticleTitleLaparoscopic colectomy vs traditional colectomy for diverticulitis. Outcome and costs Surg Endosc 10 15–18 Occurrence Handle10.1007/s004649910002 Occurrence Handle1:STN:280:BymB28znslE%3D Occurrence Handle8711597
F Siriser (1999) ArticleTitleLaparoscopic-assisted colectomy for diverticular sigmoiditis. A single-surgeon prospective study of 65 patients Surg Endosc 13 811–813 Occurrence Handle10.1007/s004649901106 Occurrence Handle10430692
JW Lumley GA Fielding M Rhodes LK Nathanson S Siu RW Stitz (1996) ArticleTitleLaparoscopic-assisted colorectal surgery Dis Colon Rectum 39 155–159 Occurrence Handle1:STN:280:BymB38znt1M%3D Occurrence Handle8620781
SA Lord SW Larach A Ferrara PR Williamson CP Lago MW Lube (1996) ArticleTitleLaparoscopic resections for colorectal carcinoma Dis Colon Rectum 39 148–154 Occurrence Handle1:STN:280:BymB38znt1I%3D Occurrence Handle8620780
PA Dean RW Beart SuffixJr H Nelson TD Elftmann RT Sclinkert (1994) ArticleTitleLaparoscopic-assisted segmental colectomy Mayo Clin Proc 69 834–840 Occurrence Handle1:STN:280:ByuA2czovVw%3D Occurrence Handle8065184
GC Hoffman JW Baker CW Fitchett JH Vansant (1994) ArticleTitleLaparoscopic-assisted colectomy Ann Surg 219 732–740 Occurrence Handle1:STN:280:ByuB28zjtVE%3D Occurrence Handle8203984
PM Falk RW Beart SuffixJr SD Wexner et al. (1993) ArticleTitleLaparoscopic colectomy Dis Colon Rectum 36 28–34 Occurrence Handle1:STN:280:ByyC3crntlw%3D Occurrence Handle8416776
CL Garrard RH Clements L Nanney JM Davidson WO Richards (1999) ArticleTitleAdhesion formation is reduced after laparoscopic surgery Surg Endosc 13 10–13 Occurrence Handle10.1007/s004649900887 Occurrence Handle1:STN:280:DyaK1M%2FovVaqsQ%3D%3D Occurrence Handle9869679
E Schippers A Tittel A Ottinger V Schumpelick (1998) ArticleTitleLaparoscopy versus laparotomy Dig Surg 15 145–147 Occurrence Handle10.1159/000018608 Occurrence Handle1:STN:280:DyaK1M%2Fmt1Witg%3D%3D Occurrence Handle9845577
DJ Hackam OD Rotstein (1998) ArticleTitleHost response to laparoscopic surgery Can J Surg 41 103–111
L Köhler D Rixen H Troidl (1998) ArticleTitleLaparoscopic colorectal resection for diverticulitis Int J Colorectal Dis 13 43–47 Occurrence Handle10.1007/s003840050130 Occurrence Handle9548100
L Krähenbühl M Schäfer V Kuzinkovas P Renzulli HU Baer MW Buchler (1998) ArticleTitleExperimental study of adhesion formation in open and laparoscopic fundoplication Br J Surg 85 826–830 Occurrence Handle10.1046/j.1365-2168.1998.00718.x Occurrence Handle1:STN:280:DyaK1czjtVaqsw%3D%3D Occurrence Handle9667717
C Huscher G Silecchia E Croce et al. (1996) ArticleTitleLaparoscopic colorectal resection Surg Endosc 10 875–879 Occurrence Handle10.1007/s004649900187 Occurrence Handle1:STN:280:ByiC2cjovFw%3D Occurrence Handle8703141
GH Ballantyne (1995) ArticleTitleLaparoscopic-assisted colorectal surgery Gastroenterologist 3 75–89 Occurrence Handle1:STN:280:ByqB287mvFI%3D Occurrence Handle7743123
JM Ramos RW Beart SuffixJr R Goes AE Ortega RT Schlinkert (1995) ArticleTitleRole of laparoscopy in colorectal surgery Dis Colon Rectum 38 494–501 Occurrence Handle1:STN:280:ByqB2MvpslY%3D Occurrence Handle7736880
WA Kmiot SD Wexner (1995) ArticleTitleLaparoscopy in colorectal surgery Br J Surg 82 25–26 Occurrence Handle1:STN:280:ByqC1cjnsV0%3D Occurrence Handle7881945
KA Zucker DE Pitcher DT Martin RS Ford (1994) ArticleTitleLaparoscopic-assisted colon resection Surg Endosc 8 12–18 Occurrence Handle1:STN:280:ByuB3cvptVE%3D Occurrence Handle8153858
JRT Monson A Darzi P Declan Carey PJ Guillou (1992) ArticleTitleProspective evaluation of laparoscopic-assisted colectomy in an unselected group of patients Lancet 340 831–833 Occurrence Handle10.1016/0140-6736(92)92694-B Occurrence Handle1:STN:280:ByyD38zhslQ%3D Occurrence Handle1357253
M Faynsod MJ Stamos T Arnell C Borden S Udani H Vargas (2000) ArticleTitleA case-control study of laparoscopic versus open sigmoid colectomy for diverticulitis Am Surg 66 841–843 Occurrence Handle1:STN:280:DC%2BD3cvktlGiuw%3D%3D Occurrence Handle10993612
L Stocchi H Nelson TM Young-Fadok DR Larson DM Ilstrup (2000) ArticleTitleSafety and advantages of laparoscopic vs. open colectomy in the elderly Dis Colon Rectum 43 326–332 Occurrence Handle1:STN:280:DC%2BD3c7psFamsw%3D%3D Occurrence Handle10733113
JJ Tuech P Pessaux C Rouge N Regenet R Bergamaschi JP Arnaud (2000) ArticleTitleLaparoscopic vs open colectomy for sigmoid diverticulitis Surg Endosc 14 1031–1033 Occurrence Handle10.1007/s004640000267 Occurrence Handle1:STN:280:DC%2BD3M%2FovFeruw%3D%3D Occurrence Handle11116412
TG Parks AM Connell (1970) ArticleTitleThe outcome of 445 patients admitted for treatment of diverticular disease of the colon Br J Surg 57 775–778 Occurrence Handle1:STN:280:CS6D38npt1A%3D Occurrence Handle5476757
CE Welch AW Allen GA Donaldson (1953) ArticleTitleAn appraisal of resection of the colon for diverticulitis of the sigmoid Ann Surg 138 332–343 Occurrence Handle1:STN:280:CyuD3c7msl0%3D Occurrence Handle13080959
N Soper L Brunt K Kerbl (1994) ArticleTitleLaparoscopic general surgery N Engl J Med 330 409–419 Occurrence Handle1:STN:280:ByuC3M7nsVM%3D Occurrence Handle8284008
J Moreaux C Vons (1990) ArticleTitleElective resection for diverticular disease of the sigmoid colon Br J Surg 77 1036–1038 Occurrence Handle1:STN:280:By6D3czisFY%3D Occurrence Handle2207569
JB Flament C Avisse D Greffier JP Palot JF Delattre (1995) ArticleTitleRéflexions sur le traitement de la sigmoidite divertculaire Chirurgie 121 43–49
J Poilleux P Delhomme M Gignoux B Joubert (1987) ArticleTitleChoix thérapeutique dans les complications de la maladie diverticulaire colique Chirurgie 113 356–359 Occurrence Handle1:STN:280:BieD3cznvFQ%3D Occurrence Handle3498610
SD Wexner P Reissman J Pfeifer M Bernstein N Geron (1996) ArticleTitleLaparoscopic colorectal surgery Surg Endosc 10 133–136 Occurrence Handle1:STN:280:ByiD1cnkt1Q%3D Occurrence Handle8932614
EH Phillips M Franklin BT Carroll M Fallas R Ramos D Rosenthal (1992) ArticleTitleLaparoscopic colectomy Ann Surg 216 703–707 Occurrence Handle1:STN:280:ByyC3czjt1c%3D Occurrence Handle1466626
AM Cooperman V Katz D Zimmon G Botero (1991) ArticleTitleLaparoscopic colon resection J Laparoendosc Surg 1 221–224 Occurrence Handle1:STN:280:By2D3szitFI%3D Occurrence Handle1834273
GS Ferzli P Sayad RN Cacchione (2001) ArticleTitleThe lateral approach to laparoscopic sigmoid colon resection J Am Coll Surg 193 105–108 Occurrence Handle1:STN:280:DC%2BD3MzovVamuw%3D%3D Occurrence Handle11442246
C Smadja M Sbai Idrissi M Tahrat et al. (1999) ArticleTitleElective laparoscopic sigmoid colectomy for diverticulitis Surg Endosc 13 645–648 Occurrence Handle10.1007/s004649901065 Occurrence Handle1:STN:280:DyaK1Mzhs1eruw%3D%3D Occurrence Handle10384067
JC Berthou P Charbonneau (1999) ArticleTitleElective laparoscopic management of sigmoid diverticulitis Surg Endosc 13 457–460 Occurrence Handle10.1007/s004649901012 Occurrence Handle1:STN:280:DyaK1M3ksVOntA%3D%3D Occurrence Handle10227941
CM Schlachta J Mamazza EC Poulin (1999) ArticleTitleLaparoscopic sigmoid resection for acute and chronic diverticulitis Surg Endosc 13 649–653 Occurrence Handle10.1007/s004649901066 Occurrence Handle1:STN:280:DyaK1Mzhs1eqsg%3D%3D Occurrence Handle10384068
ME Sher F Agachan M Bortul JJ Nogueras EG Weiss SD Wexner (1997) ArticleTitleLaparoscopic surgery for diverticulitis Surg Endosc 11 264–267 Occurrence Handle10.1007/s004649900340 Occurrence Handle1:STN:280:ByiB3snntlA%3D Occurrence Handle9079606
WR Peters JW Fleshman (1995) ArticleTitleMinimally invasive colectomy in elderly patients Surg Laparosc Endosc 5 477–479 Occurrence Handle1:STN:280:BymC1cjlt1I%3D Occurrence Handle8611997
P Reissman F Agachan SD Wexner (1996) ArticleTitleOutcome of laparoscopic colorectal surgery in older patients Am Surg 62 1060–1063 Occurrence Handle1:STN:280:ByiC3MzjvV0%3D Occurrence Handle8955249
F Agachan JS Joo M Sher EG Weiss JJ Nogueras SD Wexner (1997) ArticleTitleLaparoscopic colorectal surgery Surg Endosc 11 331–335 Occurrence Handle1:STN:280:ByiB2M%2FntVc%3D Occurrence Handle9094271
AJ Senagore MA Luchtefeld JM Mackeigan (1995) ArticleTitleWhat is the learning curve for laparoscopic colectomy? Am Surg 61 681–685 Occurrence Handle1:STN:280:ByqA2cvhtVI%3D Occurrence Handle7618806
CJ Bruce JA Coller JJ Murray DJ Schoetz SuffixJr PL Roberts LC Rusin (1996) ArticleTitleLaparoscopic resection for diverticular disease Dis Colon Rectum 39 1–6 Occurrence Handle8601342
BD Schirmer (1996) ArticleTitleLaparoscopic colon resection Surg Clin North Am 76 571–583 Occurrence Handle1:STN:280:BymB283is1M%3D Occurrence Handle8669016
JD Wishner JW Baker SuffixJr GS Hoffman et al. (1995) ArticleTitleLaparoscopic-assisted colectomy Surg Endosc 9 1179–1183 Occurrence Handle1:STN:280:BymC3s7ovFY%3D Occurrence Handle8553229
AJ Senagore MA Luchtefeld JM Mackeigan WP Mazier (1993) ArticleTitleOpen colectomy versus laparoscopic colectomy Am Surg 59 549–554 Occurrence Handle1:STN:280:ByyA3s3jtFU%3D Occurrence Handle8338287
AP Fine S Lanasa MP Gannon CW Cline R James (1995) ArticleTitleLaparoscopic colon surgery Am Surg 61 412–416 Occurrence Handle1:STN:280:ByqB2M7isFc%3D Occurrence Handle7733545
HD Vargas RT Ramirez GC Hoffman et al. (2000) ArticleTitleDefining the role of laparoscopic- assisted sigmoid colectomy for diverticulitis Dis Colon Rectum 43 1726–1731 Occurrence Handle1:STN:280:DC%2BD3M%2FpvFGqtA%3D%3D Occurrence Handle11156458
DE Fry L Milholen PJ Harbrecht (1983) ArticleTitleIatrogenic ureteral injury Arch Surg 118 454–457 Occurrence Handle1:STN:280:BiyC2M3it1U%3D Occurrence Handle6830435
HH Chen SD Wexner AJ Iroatulam et al. (2000) ArticleTitleLaparoscopic colectomy compares favorably with colectomy by laparotomy for reduction of postoperative ileus Dis Colon Rectum 43 61–65 Occurrence Handle1:STN:280:DC%2BD3c3ntFagsQ%3D%3D Occurrence Handle10813125
ME Franklin R Ramos D Rosenthal W Schuessler (1993) ArticleTitleLaparoscopic colonic procedures World J Surg 17 51–56 Occurrence Handle8447141
JD Corbitt (1992) ArticleTitlePreliminary experience with laparoscopic guided colectomy Surg Laparosc Endosc 2 79–81 Occurrence Handle1341507
M Jacob JC Verdeja HS Goldstein (1991) ArticleTitleMinimally invasive colon resection (laparoscopic colectomy) Surg Laparosc Endosc 1 144–150 Occurrence Handle1:STN:280:ByuD1c%2FkslA%3D Occurrence Handle1688289
KL Leung SP Kwok WY Lau et al. (1997) ArticleTitleLaparoscopic assisted resection of rectosigmoid carcinoma. Immediate and medium-term results Arch Surg 132 761–764 Occurrence Handle1:STN:280:ByiA2svktFc%3D Occurrence Handle9230862
ME Franklin SuffixJr D Rosenthal D Abrego-Medina et al. (1996) ArticleTitleProspective comparison of open vs. laparoscopic colon surgery for carcinoma Dis Colon Rectum 39 35–46
AE Ortega RW Beart SuffixJr GD Steele SuffixJr DP Winchester FL Greene (1995) ArticleTitleLaparoscopic bowel surgery registry Dis Colon Rectum 38 681–685 Occurrence Handle1:STN:280:ByqA3s7gslA%3D Occurrence Handle7607025
AM Lacy JC Garcia-Valdecasas JM Pique et al. (1995) ArticleTitleShort-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer Surg Endosc 9 1101–1105 Occurrence Handle10.1007/BF00188458 Occurrence Handle1:STN:280:BymC3MfhtVY%3D Occurrence Handle8553212
AR Stevenson R Stitz J Lumley G Fielding (1995) ArticleTitleLaparoscopically assisted anterior resection for diverticular disease Ann Surg 227 335–342
Author information
Authors and Affiliations
About this article
Cite this article
Dwivedi, A., Chahin, F., Agrawal, S. et al. Laparoscopic Colectomy vs. Open Colectomy For Sigmoid Diverticular Disease. Dis Colon Rectum 45, 1309–1315 (2002). https://doi.org/10.1007/s10350-004-6415-6
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-6415-6