Feasibility of laparoscopic resection for perforated diverticulitis: a retrospective observational study of 77 consecutive patients

Abstract

Background

Perforated colonic diverticulitis with purulent or fecal contamination (PCD) is a surgical emergency with high morbidity and mortality. Traditionally, open surgery as a Hartmann procedure (HP) has been performed. Feasibility of the laparoscopic approach (LA) either with primary anastomosis (PA) or as an HP has been shown, but evidence and implementation into daily routine remain low. We analysed all patients with PCD and emergency surgery at our institution to compare post-operative outcomes between LA and open surgery. Our results should add more evidence about the potential benefit of LA in treating PCD.

Methods

This retrospective analysis conducted at a tertiary care centre in Germany included all patients with PCD undergoing emergency surgery between June 2007 and February 2019. Mortality and postoperative morbidity according to Clavien-Dindo-Classification are the primary endpoints. Secondary endpoints were stoma-free survival and length of hospital stay.

Results

Seventy-seven patients were identified (41 female/36 male; median age 67.9 years). Sixty patients underwent a LA (conversion in 9 of 60, 15%). PA has been performed in 25 of 77 patients (22 LA, 3 with open surgery). Severe complications and death (Clavien-Dindo-Classification grade IIIb-V) were lower in patients with LA (17/60, 28%) compared to open surgery (9/17, 53%; p = 0.082) as well as the length of hospital stay (LOS; LA 9 days vs. open surgery 17 days; p = 0.016).

Conclusion

The LA is feasible in the majority of patients with PCD and may be warranted as a routine in emergency surgery. Although limited by a selection bias of this retrospective study, the LA seems to reduce morbidity and LOS.

Keywords:

• Perforated diverticulitis
• emergency surgery
• laparoscopic surgery
• sigmoidectomy

Acknowledgements

Part of the results have been presented as a poster at the 14th Scientific and Annual Meeting of the European Society of Coloproctology (ESCP). This meeting took place in Vienna, Austria, September 25–27, 2019.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

This is a retrospective analysis of prospectively collected data retrieved from the hospital information and surgical planning system (SAP). Datasets generated or analysed during this study are included in this published article, anonymised source data are available from the corresponding author upon reasonable request.

Additional information

Funding

This study was funded by Helios Research Center Research Center [ID 045544].