Can laparoscopically assisted sigmoid resection provide uncomplicated management even in cases of complicated diverticulitis?

Background: Laparoscopically assisted sigmoid resection has become an accepted method for treating uncomplicated diverticulitis. This prospective study aimed to compare the results of laparoscopic sigmoid resection for uncomplicated and complicated sigmoid diverticular disease used to check the indication for the complicated stages of diverticulitis. Methods: All patients who underwent laparoscopic resection for sigmoid diverticulitis at the authors' hospital between 1999 and 2005 were divided into two groups: group 1 (uncomplicated diverticular disease) and group 2 (complicated diverticular disease). The exclusion criteria specified generalized peritonitis, signs of sepsis, and extensive previous abdominal surgery. Results: Of the 203 patients (108 men and 95 women) who underwent laparoscopically assisted resection during the examination period, 112 were assigned to group 1 and 91 to group 2. Differences in favor of group 1 were found for the duration of surgery (154 vs 166 min), the conversion rate (1.8% vs 9.9%), the postoperative wound infections (2.7% vs 13.2%), and the postoperative hospitalization period (12.3 +/- 3.9 vs 15.0 +/- 5.6 days). No significant differences were seen in any other areas such as completion of nutritional buildup (4.6 vs 5.0 days) or time until the first postoperative bowel movement (2.8 vs 3.3 days). Total postoperative morbidity (16.1% vs 26.4%; p = 0.10) tended to be increased in group 2, but this difference was not statistically significant. Conclusions: Laparoscopic sigmoid resection can be performed for patients who have complicated diverticulitis without significantly increasing their overall morbidity. This group of patients could benefit from the advantages of the minimally invasive procedure despite a longer operating time and a higher conversion rate.