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Background: Although functional end-to-end anastomosis (FEEA) using a stapler in the colorectal field has been recognised worldwide, the technique varies by surgeon, and the safety of anastomosis using different techniques is unknown. Methods: This multicentre prospective observational cohort study was conducted by the KYCC Study Group in Yokohama, Japan, and included patients who underwent colonic resection at seven centres between April 2020 and March 2022. This study compared the incidence of surgery-related abdominal complications (SAC: anastomotic leakage [AL], anastomotic bleeding, intra-abdominal abscess, enteritis, ileus, surgical site infection, and other abdominal complications) between two different methods of FEEA (one-step [OS] method: simultaneous anastomosis and bowel resection; two-step [TS] method: anastomosis after bowel resection). Complications of Clavien–Dindo classification grade 2 or higher were assessed. Results: Among 293 eligible cases, the OS and TS methods were used in 194 (66.2%) and 99 (33.8%) patients, respectively. The baseline characteristics were similar between the groups. The OS method used fewer staplers (three vs. four staplers, p < 0.00001). There were no significant differences in SAC rate between the OS (19.1%) and the TS (16.2%) groups (p = 0.44). The OS group had four cases (2.1%) of AL (two patients; grade 3, two patients; grade 2) while the TS group had one case (1.0%) of grade 2 AL (p = 0.67). Multivariate logistic regression analysis showed that male sex (odds ratio [OR] 3.95; p < 0.00001), an open surgical approach (OR 2.36; p = 0.03), and longer operative duration (OR,2.79; p = 0.002) were independent predictors of complications, whereas the OS method was not an independent predictor (OR 1.17; p = 0.66). Conclusions: The OS and the TS technique for stapled colonic anastomosis in a FEEA had a similar postoperative complication rate. Trial registration number: UMIN000039902 (registration date 23 March 2020). [ABSTRACT FROM AUTHOR]

Purpose: The optimal treatment strategy of patients affected by colorectal cancer (CRC) with synchronous unresectable liver metastases (SULM) is at present undefined. It is not known if a palliative primary tumor resection followed by chemotherapy could have a survival benefit compared to upfront chemotherapy (CT). The aim of the study is to analyze the safety and effectiveness of both therapeutic strategies in a group of patients treated at one institution. Methods: A prospectively collected database was queried for patients affected by colorectal cancer with synchronous unresectable liver metastases between January 2004 and December 2018, defining and comparing 2 groups: patients treated by chemotherapy alone (group 1) vs patients who underwent primary tumor resection with or without a first line chemotherapy (group 2). The primary end point was Overall Survival (OS), estimated by the Kaplan–Meier method. Results: One hundred sixty-seven patients were included: 52 in group 1 and 115 in group 2, median follow-up 48 months (range 25–126). A difference of 14 months in overall survival was observed between group 2 compared to group 1 (28 vs 14 months respectively; p < 0.001). Furthermore, overall survival increased in patients who underwent liver metastases resection (p < 0.001) or percutaneous radiofrequency ablation after surgery (p < 0.001). Conclusion: With the limits of a retrospective analysis, the study shows that surgical resection of the primary tumor has a significant impact on survival compared to chemotherapy alone. Randomized controlled trials are needed to confirm these data. [ABSTRACT FROM AUTHOR]

Gastrectomy and gastric bypass improve type 2 diabetes (T2DM), potentially through alterations in intestinal hormones and the microbiome. The aim of this study was to analyze whether colorectal resections result in improvement of T2DM. A total of 171 patients with T2DM who underwent colectomy for benign diseases were studied with a median postoperative follow-up of 3 years (interquartile range [IQR] 1–5). The median BMI and glycated hemoglobin (HbA1c) at baseline and post-colectomy were 30.3 kg/m2 (IQR 26.6–34.6) versus 30.4 kg/m2 (IQR 26.2–35) (p = 0.1), and 6.7% (IQR 6.2–7.5) versus 6.5% (IQR 6.5–7.1) (p = 0.5), respectively. The proportion of patients taking diabetes medications at baseline versus post-colectomy did not differ significantly. Changes in BMI, HbA1c, and status of diabetes medications were not statistically different between the subtypes of colorectal resection. Our experience suggests that colectomy for benign colorectal diseases is not associated with long-term changes in body weight or glycemic control. [ABSTRACT FROM AUTHOR]

The real diffusion of laparoscopy for the treatment of colorectal diseases in Italy is largely unknown. The main purpose of the present study is to investigate among surgeons dedicated to minimally invasive surgery, the volume of laparoscopic colorectal procedures, the type of operation performed in comparison to traditional approach, the indication for surgery (benign and malignant) and to evaluate the different types of technologies used. A structured questionnaire was developed in collaboration with an international market research institute and the survey was published online; invitation to participate to the survey was issued among the members of the Italian Society of Endoscopic Surgery (SICE). 211 surgeons working in 57 surgical departments in Italy fulfilled and answered the online survey. A total of 6357 colorectal procedures were recorded during the year 2015 of which 4104 (64.1%) were performed using a minimally invasive approach. Colon and rectal cancer were the most common indications for laparoscopic approach (83.1%). Left colectomy was the operation most commonly performed (41.8%), while rectal resection accounted for 23.5% of the cases. Overall conversion rate was 5.9% (242/4104). Full HD standard technology was available and routinely used in all the responders' centers. The proportion of colorectal resections that are carried out laparoscopically in dedicated centers has now reached valuable levels with a low conversion rate. [ABSTRACT FROM AUTHOR]

Applications for surgical staplers continue to grow, due to the increase in minimally invasive surgical approaches, and range from vessel ligation to tissue transection and anastomoses. Complications associated with stapled tissue, such as bleeding or leaks, continue to be a concern for surgeons, as both can be associated with prolonged operative times and can contribute to postoperative morbidity and mortality. The goal of this retrospective study was to evaluate the performance of the da Vinci® Xi EndoWrist® Stapler 45 with SmartClamp™ technology during robotic-assisted right colectomy with intracorporeal anastomosis. We reviewed 113 consecutive cases from four medical centers. Preclinical diagnoses were inflammatory bowel disease (IBD) (n = 5), benign bowel disease (n = 77), and malignant bowel disease (n = 31). No anastomotic leaks occurred; one event of anastomotic bleeding (0.88%) resolved without surgical intervention. Overall, there were 643 clamp attempts (5.7 attempts per case), and 570 fires (5.0 fires per case). SmartClamp™ occurrences happened in approximately one out of three cases, with the highest proportion of occurrences in the IBD group (2.0 occurrences per case). The most commonly fired reload was blue (1.5 mm closed height) with 4.1 blue reloads fired per case overall. No incomplete fires occurred during the procedures. The study data demonstrate the performance of the da Vinci Xi EndoWrist® Stapler 45 as used in right colon resection with intracorporeal anastomosis. The collection and analysis of these data provide surgeons with information related to stapler firings, which were not previously available; as such, this analysis may lead to deductions that are useful for intraoperative decision-making and clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Patients with severe chronic obstructive pulmonary disease (COPD) are at a higher risk for postoperative respiratory complications. Despite the benefits of a minimally invasive approach, laparoscopic pneumoperitoneum can substantially reduce functional residual capacity and raise alveolar dead space, potentially increasing the risk of respiratory failure which may be poorly tolerated by COPD patients. This raises controversy as to whether open techniques should be preferentially employed in this population.Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2011 to 2014 was used to examine the clinical data from patients with COPD who electively underwent laparoscopic and open colectomy. Patients defined as having COPD demonstrated either functional disability, chronic use of bronchodilators, prior COPD-related hospitalization, or reduced forced expiratory reserve volumes on lung testing (FEV1 <75%). Demographic data and preoperative characteristics were compared. Linear and logistic regressions were utilized to perform multivariate analysis and determine risk-adjusted outcomes.Results: Of the 4397 patients with COPD, 53.8% underwent laparoscopic colectomy (LC) while 46.2% underwent open colectomy (OC). The LC and OC groups were similar with respect to demographic data and preoperative comorbidities. Equivalent frequencies of exertional dyspnea (LC 35.4 vs OC 37.7%, P = 0.11) were noted. After multivariate risk adjustment, OC demonstrated an increased rate of overall respiratory complications including pneumonia, reintubation, and prolonged ventilator dependency when compared to LC (OR 1.60, 95% CI 1.30-1.98, P < 0.01). OC was associated with longer length of stay (10 ± 8 vs. 6.7 ± 7 days, P < 0.01) and higher readmission (OR 1.36, 95% CI 1.09-1.68, P < 0.01) compared to LC.Conclusion: Despite the potential risks of laparoscopic pneumoperitoneum in the susceptible COPD population, a minimally invasive approach was associated with lower risk of postoperative respiratory complications, shorter length of stay, and decrease in postoperative morbidity. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the prevalence of lymphoid hyperplasia in the lower gastrointestinal tract and its role in patients undergoing colonoscopic examinations, particularly focusing on any allergic predisposition. Methods: A database search performed at the Department of Gastroenterology at Onomichi Municipal Hospital identified seven patients with lymphoid hyperplasia in the large intestine (i.e., cecum, colon, and/or rectum). Data regarding the endoscopic, biological, and pathological examinations performed and the allergic histories for each patient were retrospectively reviewed from the clinical records. Results: Median age of the patients (four males, three females) was 50 years. Lymphoid hyperplasia was seen in the cecum ( n = 5), ascending colon ( n = 2), and transverse colon ( n = 1). Six patients (85.7 %) had one of the allergic airway diseases: allergic rhinoconjunctivitis for pollen ( n = 3), bronchial asthma ( n = 1), infantile asthma ( n = 1), or allergic bronchitis ( n = 1). Drug allergy ( n = 3) and urticaria ( n = 2) were also found. All seven patients had one or more allergic diseases; however, none had a history of food allergy. Blood tests for allergens revealed that six patients (85.7 %) had positive reactions to inherent allergens, whereas only one patient had a positive reaction to food allergens. Conclusions: Our results indicate that lymphoid hyperplasia in the large intestine may be associated with allergic airway diseases rather than with food allergies; thus, its presence may be useful to detect patients with underlying airway hyperreactivity. [ABSTRACT FROM AUTHOR]

Purpose: We wished to determine the effects of laparoscopic resection using natural orifice specimen extraction (NOSE) for patients with colorectal disease through a meta-analysis. Methods: A study search was undertaken in PubMed, EMBASE, and Cochrane databases for eligible studies until December 2014. Duration of hospital stay, operation time, time to first flatus, pain score, cosmetic result, postoperative complications, and disease-free survival (DFS) were the main endpoints. The results were analyzed using RevMan v5.3. Results: Nine clinical studies involving 837 patients were included for final analyses. Laparoscopic resection with NOSE had a shorter duration of hospital stay (weighted mean difference (WMD) = −0.62 days, 95 % confidence interval (CI) [−0.95, −0.28], p < 0.01) and time to first flatus (WMD = −0.59 days, 95 % CI [−0.78, −0.41], p < 0.01), less postoperative pain (WMD = −1.43, 95 % CI [−1.95, −0.90], p < 0.01), and postoperative complications (odds ratio (OR) = 0.51, 95 % CI [0.36, 0.74], p < 0.01) with better cosmetic result (WMD = 1.37, 95 % CI [0.59, 2.14], p < 0.01). However, the operation time was significantly longer in the NOSE group (WMD = 20.97 min, 95 % CI [4.33, 37.62], p = 0.01). No significant difference was observed in DFS (hazard ratio (HR) = 0.88, 95 % CI [0.49, 1.57], p = 0.67). Conclusion: Our meta-analysis supported the notion that laparoscopic resection with NOSE for colorectal disease can significantly reduce the duration of hospital stay, accelerate postoperative recovery with better cosmetic results, and in particular, result in less postoperative pain and fewer complications. [ABSTRACT FROM AUTHOR]

Objectives: Colorectal polyps are among the common causes for rectal bleeding in children. We studied the clinical, colonoscopic, and histopathological features of colorectal polyps and polyposis syndrome in Indian children and adolescents. Methods: Medical records of children and adolescents with colorectal polyps and polyposis syndrome were retrospectively reviewed from 2001 to 2014 at Department of Gastroenterology, in large tertiary care center of Mumbai. Results: A total of 120 patients were found to have colonic polyps during study period. Mean age of presentation in children was 7.31 ± 4.05 years (range 2 to 19 years), with male-to-female ratio of 2.16:1. Rectal bleeding was presenting symptom in 95.8 % with mean duration of 12.6 ± 15 months. Majority of polyps (77.5 %) were juvenile, and 97.2 % were located in left colon. Solitary polyps were seen in 76.6 %, multiple polyps in 11.6 %, juvenile polyposis syndrome in 6.6 %, familial adenomatous polyposis in 4.2 %, and Peutz-Jeghers syndrome in 0.8 % of the children. The polyposis syndrome group had higher age at presentation ( p = 0.00006), greater likelihood of anemia, abdominal pain, and diarrhea ( p = 0.0001, 0.0002, and 0.0051, respectively). Likelihood of adenomatous change in polyps was higher in polyposis syndrome group ( p = 0.0003). Left colonic polyps were more common in non-polyposis group, whereas pan-colonic polyps were more common in polyposis syndrome group ( p < 0.00001). Conclusion: Presence of anemia, abdominal pain, diarrhea, higher age at presentation (more than 10 years), and history of polypectomy are clinical indicators of polyposis syndrome. [ABSTRACT FROM AUTHOR]

Purpose: The published data on the evaluation of feasibility and safety of single-incision laparoscopic colorectal surgery (SILC) compared with traditional multiport laparoscopic colorectal surgery (MLC) remained controversial. The present cumulative meta-analysis and systematic review were performed to provide a more objective and precise estimate. Materials and methods: PubMed, the Cochrane Library, and also, manual searches were employed to identify potentially eligible studies which were published before June 7, 2012. The association was assessed by odds ratio (OR) and means with 95 % confidence intervals (CI). Results: A total of 20 comparative studies were included, with 670 patients underwent SILC and 838 patients underwent MLC. For overall pooled estimates, no evidence of between trial differences was found in overall conversion rate (OR, 1.7; 95 % CI, 0.97 to 3.01), overall complication rate (OR, 0.82; 95 % CI, 0.63 to 1.08), and operative time (mean, −3.59; 95 % CI, −10.95 to 3.77); significantly between trial differences were found in estimated blood loss (mean, −18.61; 95 % CI, −31.33 to −5.90) and post-operative hospital stay (mean, −0.54; 95 % CI, −0.95 to −0.12). The cumulative meta-analysis identified a potentially increased conversion rate of SILC compared with MLC with the increased percentage of malignancies, but no significant differences could be identified in overall complication rate. Conclusion: This meta-analysis suggested the feasibility and safety of SILC performed by experienced hands, though potentially higher overall conversion rate occurred in malignancies. SILC will benefit the patients much more with its superiority over MLC. [ABSTRACT FROM AUTHOR]

Background Hand-assisted laparoscopic surgery (HALS) has gained wide clinical acceptance as a practical alternative to laparoscopically assisted surgery (LAP) for the surgical treatment of complex colorectal diseases (e.g., ulcerative colitis and diverticulitis). However, its role in the further challenging operation for Crohn's colitis (i.e., subtotal or total colectomy) has yet to be established. This study aimed to evaluate the feasibility, safety, and potential benefit of HALS subtotal and total colectomy for Crohn's colitis. Methods The study reviewed 38 consecutive patients who underwent subtotal or total colectomy as their initial abdominal surgery for Crohn's extensive colitis (involvement of 3 or more colonic segments) between 1992 and 2006. The patients were divided into three groups (open, LAP, and HALS), and their background and postoperative data were retrospectively analyzed. Results The reviews included 14 open, 6 LAP, and 18 HALS cases. The groups were comparable in terms of age at surgery, gender, body mass index, extent and type of disease, indications, and procedures. The median operative time was significantly longer for LAP (330 min; range, 154-540 min) than for HALS (251 min; range, 165- 340 min) or open surgery (200 min; range, 172-315 min). The blood loss was significantly less with LAP (170 ml; range, 115-257 ml) and HALS (225 ml; range, 35-890 ml) than with open surgery (438 ml; range, 280-780 ml). No difference was seen in postoperative complications, and no mortality occurred in the series. Conclusions The findings showed that HALS subtotal and total colectomies are feasible and safe. The HALS procedure currently seems potentially beneficial for patients with extensive Crohn's colitis by reducing the operative time for laparoscopic surgery while retaining its less invasiveness. [ABSTRACT FROM AUTHOR]

Purpose: Hand-assisted laparoscopic surgery (HALS) is increasingly used for complex and extensive colorectal diseases, such as a restorative proctocolectomy (RP) for ulcerative colitis (UC). However, the optimal instrumentation for this procedure has yet to be determined. This study reviewed the optimization of the instrumentation employed for HALS-RP and evaluated their impact in standardizing HALS-RP for UC. Methods: Sixty-six cases with HALS-RP for UC were reviewed. Cases were divided into subgroups according to (1) hand-access devices and (2) vascular control devices, and their intraoperative/postoperative outcomes were compared. Results: All groups had comparable backgrounds. (1) The hand-access devices employed were first LapDisc ( n = 14), then HandPort ( n = 25), and recently GelPort ( n = 27). The surgical time was shortest in GelPort group in comparison to the other two groups. (2) Laparosonic coagulating shears (LCS) with clips were used for vascular control in the first 29 patients, and the bipolar vessel sealing system (LigaSure) was employed in the 37 subsequent patients. The surgical time was shorter and blood loss was less in the LigaSure group. No differences were seen in postoperative outcomes, including the complication rate and length of hospital stay. Conclusion: The new instrumentation contributed to improved outcome of HALS-RP. HALS-RP can become a more comfortable and standardized procedure for UC with the adoption of evolving technologies. [ABSTRACT FROM AUTHOR]

The Stirling Royal Infirmary Rapid Access Colorectal Clinic (RACC) is a one-stop clinic that uses flexible sigmoidoscopy as the initial investigation to diagnose patients referred urgently with colorectal symptoms. This study aimed to examine the diagnoses and outcomes of patients who attended the RACC in 2006. All patients who attended the RACC from 1 January 2006 to 31 December 2006 were identified and retrospectively reviewed from our prospectively collected unit database and case notes. Five hundred ninety-one patients attended the RACC in 2006. One hundred sixteen (19.6%) patients were discharged after the first clinic attendance, and the remaining 475 (80.4%) had further investigations or clinic review. There were 370 barium enemas requested with 92.4% compliance. The most common pathology identified by barium enemas was diverticular disease which only required reassurance and lifestyle changes. There were nine false-positive findings from barium enemas requiring further investigations. Of the 105 patients without barium enema, 49 had a colonoscopy. In total, 42 colorectal cancers were diagnosed with 34 (81.0%) distal to the splenic flexure and eight (19.0%) proximal. Of these, 32 (76%) were diagnosed by flexible sigmoidoscopy, three (7%) by barium enemas, three (7%) by colonoscopy, and four (10%) by computed tomography. A rapid access colorectal clinic using flexible sigmoidoscopy as the initial diagnostic test was safe and effective in investigating distal colonic pathologies. However, over two thirds of patients proceeded to imaging of the remaining colon, and most of them were found to have only benign pathologies. The cost effectiveness and acceptability of this were unclear. [ABSTRACT FROM AUTHOR]

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The purpose of this retrospective study was to evaluate the accuracy of MRI using pelvic-phased-array and endocavitary coils in detecting intestinal wall invasion by an endometriotic nodule. Forty-seven patients (32.1 ± 4.2 years) who were planned for a surgical cure of deep endometriosis underwent MRI with conventional sequences using both coils. A thin bright layer on T2-w with enhancement on post-Gd T1-w defined our MR pattern for muscular layer involvement. MR results were correlated with surgical and pathological findings of the removed nodule. MR results for Group 1 (both coils) achieved a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100–63%, 96–92%, 90–70%, 100–85%, and 97–83% for endovaginal coil and phased-array coil, respectively. Group 2 (phased-array coil) had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 73%, 93%, 84%, 88%, and 87% for this coil, respectively. Combined pelvic-phased-array and endovaginal coils are better than phased array alone in the detection of intestinal wall invasion. Easy to perform, it has to be considered as a preoperative staging for deep posterior endometriosis to orientate the surgical management. [ABSTRACT FROM AUTHOR]

Adhesions are a major risk for visceral injury and can increase the difficulty of both laparoscopic and open colectomy. The aim of the present study was to evaluate the impact of previous abdominal surgery on laparoscopic colectomy in terms of early outcome. We performed a case-control study of patients who underwent laparoscopic colectomy for colorectal disease. The case group comprised 91 patients with a history of prior abdominal surgery, while the 91 controls had no such history. Case and controls were matched for age, gender, site of primary disease, comorbidity on admission and body mass index. The two groups were homogeneous for demographic and clinical characteristics. Conversion rate was 16.5% in the case group and 8.8% in the control group ( p=0.18). Of the 7 patients who underwent conversion because of adhesions, six had prior surgery (cases) and one did not ( p=0.001). Operative time was 26 minutes longer in the case group than in the control group ( p=0.001). Morbidity rate was 25.3% among cases and 23.1% for controls. Patients in the two groups experienced a similar time to recovery of bowel function, length of postoperative stay, and 30-day readmission rate. Laparoscopic colectomy in previously operated patients is a time-consuming operation, but it does not appear to affect the short-term postoperative outcome. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the feasibility of low-pressure pneumoperitoneum in laparoscopic colorectal surgery.Methods: The authors designed low-pressure (8 mmHg) laparoscopy combined with abdominal wall lift simply by placement of anchoring sutures around the camera port.Results: The operative indications were 176 colon cancers, 297 rectal cancers, and 45 benign diseases. The average blood loss was 92 ml (range, 20-1200 ml), and the mean operating time was 204 min (range, 23-525 min). Conversion to an open procedure was required in eight cases (1.5%). Two patients experienced intraoperative complications. The mean number of removed lymph nodes was 28.9 in the colon cancer cases and 23.1 in the rectal cancer cases. The mean length of resected specimen was 27.3 cm (range, 8.5-136 cm). Postoperatively, cardiopulmonary complications developed in five patients (0.9%).Conclusions: Abdominal wall lifting by anchoring sutures around the camera port in addition to low-pressure pneumoperitoneum is a simple, safe, and effective method for laparoscopic colorectal procedure. [ABSTRACT FROM AUTHOR]

We report two patients with endometriosis of the rectovaginal septum in whom endovaginal ultrasound (US) and magnetic resonance imaging (MRI) played crucial roles in the diagnosis, staging, and follow-up of the disease. The specific features of endometriosis of the rectovaginal septum on MRI and transvaginal US enable a noninvasive diagnosis, thereby reducing diagnostic delay and avoiding unnecessary invasive procedures. [ABSTRACT FROM AUTHOR]

Background: We compare the use of the HandPort(TM)device in hand-assisted laparoscopic surgery (HALS) to standard laparoscopic surgery (SLS) in the treatment of colorectal disease.Methods: A prospective, randomized, multicenter study was conducted with the participation of 10 advanced laparoscopic surgeons. Forty patients with indications for elective resection of benign colorectal disease or incurable malignant disease were randomized to one of the two treatment arms (22 HALS, 18 SLS). Main outcome measures included operative time, blood loss, HandPort(TM) performance, postoperative pain, time to oral intake, return of bowel function, length of stay, morbidity, and functional recovery.Results: The patients in each group were similar with regard to age, sex, weight, diagnosis, coexisting medical disease, and preoperative functional status. Operative time was comparable for hand-assisted laparoscopy (152 +/- 66 min) and standard laparoscopy (141 +/- 54 min) (p = 0.58). Incision length for specimen extraction/bowel anastomosis was similar (HALS 7.4 cm vs SLS 7.0 cm). Three of 22 HALS cases (14%) were converted, as compared with four of 18 (22%) in the laparoscopy group (p = 0.68). Return of bowel function occurred by the 3rd postoperative day for the majority of patients in both groups (HALS 77%, SLS 78%). There was no difference in length of stay (HALS 7.0 days [range, 2-12] vs SLS 6.0 days [range, 2-10], p = 0.25). Severity of postoperative pain and rate of functional recovery were equivalent. One major complication occurred in each group. There were three wound infections in the laparoscopy group. No patient required reoperation, and there were no deaths.Conclusions: Hand-assisted laparoscopic surgery is safe and effective for benign and noncurative colorectal resection. As compared to standard laparoscopic surgery, hand-assisted laparoscopy retains the benefits of minimally invasive surgery and may allow the surgeon to perform complex operations more easily. [ABSTRACT FROM AUTHOR]

Background: Sigmoid diverticulitis is a common benign condition; however, cases of acute and chronic diverticulitis may be difficult for the surgeon to treat. We designed a study to compare the outcomes of patients who undergo laparoscopic resections for sigmoid diverticulitis with those who have similar resections for other indications.Methods: From a prospectively accumulated database of 397 consecutive laparoscopic colorectal procedures performed by three surgeons, we reviewed the outcomes of 178 patients who underwent laparoscopic sigmoid resections with primary anastomosis.Results: Laparoscopic sigmoid colectomies or anterior resections were performed in 22 patients with acute diverticulitis (AD), 70 patients with chronic diverticulitis (CD), and 86 patients with nondiverticular disease (ND). Patients with ND were significantly older than those with AD or CD (67 +/- 14 year versus 55 +/- 13 year, 55 +/- 12 year, p < 0.05). Conversion to open surgery was required in three AD patients (14%), three CD patients (4%), and 17 ND patients (20%) (chi2 = 8.23, p = 0.016). In cases completed laparoscopically, there was no significant difference in median operative time (AD, 165 min; CD, 150 min; ND, 165 min), proportion of patients with intraoperative complications (AD, one; CD, six; ND, one), or postoperative complications (AD, four; CD, 13; ND, 11). The occurrence of a postoperative complication significantly prolonged median time to full diet (4 days vs 3 days, p < 0.001) and discharge (9 days vs 5 days, p < 0.001) but not return to normal activity (16 days vs 15 days).Conclusions: In this study, patients who underwent laparoscopic sigmoid colectomies and anterior resections had similar outcomes regardless of diagnosis. This finding substantiates our view that laparoscopic resections for diverticulitis can be performed safely and with the same benefits as resections for other indications. [ABSTRACT FROM AUTHOR]