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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