LAPAROSCOPIC AND ROBOTIC-ASSISTED SURGERY FOR COMPLICATED DIVERTICULITIS

The article presents the results of a longtime experience with the effects of perioperative intestinal decontamination in patients with complicated diverticulitis on the incidence of postoperative complications following delayed minimally invasive sigmoid colectomy and colorectal anastomosis creation. PURPOSE. This work aims to evaluate the prophylactic potential of selective perioperative intestinal decontamination in patients with sigmoid diverticulitis due to perforation of the inflamed diverticula, as a form of diverticular disease; to study the incidence of postoperative complications in patients with complicated diverticulitis following laparoscopic and robotic-assisted surgery. MATERIALS AND METHODS. We studied the short-term postoperative outcomes of 179 patients with sigmoid diverticulitis associated with perforation of the inflamed diverticula using both prospective and retrospective methods. The study participants were divided into two groups: Group A (n=91) (50.8%)), of which 65 patients (36.3%) underwent laparoscopic and 26 patients (14.5%) - robotic-assisted surgery and received intestinal decontamination peri-operatively, and Group B, consisting of 88 patients (49.2%), who underwent laparoscopy but did not receive intestinal decontamination. In all cases, sigmoid colectomy was performed and a primary colorectal anastomosis was formed. RESULTS. Of 179 patients included in the study, 136 (76%) did not develop postoperative complications. In Group A, 11 (12%) of 91 patients and in Group B, 17 (19.3%) of 88 patients developed postoperative complications specific to the type of surgery undertaken. The most common complications included colorectal anastomotic leakage, adhesive intestinal obstruction, anastomotic bleeding, intra-abdominal hemorrhage and localized peritonitis. A statistical comparison revealed no statistically significant differences between the groups studied. 8 (8.8%) of 91 patients in Group A and in 7 (8.0%) of 88 patients in Group B were diagnosed with extra-abdominal ( nonsurgical) complications. Thus, the total postoperative complication rate was lower in Group A (n=19 (20.9%) than in Group B (n=24 (27.3%)) (X-2=1.002, p=0.316). Colorectal anastomotic leakage rates were lower in Group A ( n=1 (1.1.%)) than in Group B (n=4 (4.6%)) (F=0.205, p>0.05). Wound infection rates in Group A were 6.6% (n=6) patients and in Group B - 11.3% (n=10) patients (X-2*=6.483, p=0.01). No deaths were reported. CONCLUSION. Selective intestinal decontamination combined with oral decontaminating solutions has been shown to reduce the occurrence of colorectal anastomotic leaks, wound infection, surgical and general postoperative complications.