Page 23 - Tina van Loon
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Emergency surgery for diverticulitis
Introduction
The optimal treatment for complicated colonic diverticulitis remains a subject of
considerable debate. Advancing technologies and insights have introduced
laparoscopy as new approach for different treatments such as intra‐abdominal
lavage and definitive treatment with a primary anastomosis as feasible therapeutic
1
options. Even though conservative treatment with observation and antibiotics
have become one of the strategies for complicated diverticulitis, a Hartmann’s
procedure (HP, a (recto)sigmoid resection with formation of an end colostomy)
continues to be a valuable procedure in the management of complicated
2
diverticulitis to this day.
Implementation of laparoscopy has led to reduction in postoperative morbidity,
mortality and length of hospital stay in colorectal surgery, even in the era of
3
enhanced recovery programs. Therefore, it is not surprising that surgeons have
been applying laparoscopy in the treatment of complicated diverticulitis, in an
effort to reduce the high rates of morbidity and mortality of this disease. Studies
have shown that laparoscopic sigmoidectomy in diverticulitis has led to faster
recovery, less postoperative pain, reduction of major adverse events and improved
4‐6
quality of life. Use of laparoscopy, however, still remains controversial, especially
1
in hospitals without sufficient laparoscopic experience.
Our center is a large community teaching hospital in the Netherlands.
Implementation of laparoscopic surgery in 2011 resulted in a transition in all of our
gastro‐intestinal surgical procedures from a primarily open to primarily
laparoscopic approach. Primary aim of this study was to evaluate the changes in
surgical outcome defined as postoperative mortality, morbidity and length of stay
after emergency sigmoidectomy for perforated diverticulitis in our hospital over
time, also considering the period of implementation of laparoscopy. Moreover, we
are interested in the stoma reversal rates of patients after HP in our center and if
stoma reversal has increased over time, especially after introduction of
laparoscopy. We postulated that the implementation of laparoscopy in emergency
sigmoidectomy has improved our postoperative results by decreasing
postoperative complication rates and length of stay.
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