Unplanned robotic conversion-to-open is associated with worse outcomes than completed cases and outcomes that more closely resemble traditional open colorectal surgery. Patients should be counseled with regard to minimally invasive conversion rates and outcomes. The continued pursuit of technological advancements that decrease the risk for conversion in minimally invasive colorectal surgery is clearly warranted.

No abstract

BACKGROUND: There are currently no guidelines on the management of right colon diverticulitis. Treatment options have been extrapolated from the management of left-sided diverticulitis. Gaining knowledge of the risk and morbidity of diverticulitis recurrence is integral to weighing the benefit of elective surgery for right-sided diverticulitis. OBJECTIVE: The purpose of this study was to summarize the recurrence rate and the morbidity of recurrence of Hinchey classification I/II, right-sided diverticulitis following nonoperative management. DATA SOURCES: PubMed, EMBASE, and Cochrane Database of Collected Reviews were searched up to June 2019. STUDY SELECTION: Observational cohort studies evaluating outcomes following nonoperative management were reviewed. No randomized controlled trials were available. INTERVENTIONS: Intravenous antibiotics with or without percutaneous drainage of associated abscess were administered. MAIN OUTCOME MEASURES: The primary outcomes measured were the recurrence rate and morbidity associated with recurrence. Two independent investigators extracted data. The rates of recurrence were pooled by using a random-effects model. RESULTS: There were 1584 adult participants from a total of 11 studies (9 retrospective cohort and 2 prospective cohort studies) included in the analysis. Over a median follow-up period of 34.2 months, the pooled recurrence rate was 12% (95% CI, 10%–15%). Twenty of 202 patients (9.9%) required urgent surgery at the time of first recurrence. There was no mortality. Subset analysis excluding 3 studies that included percutaneous drainage as a nonoperative treatment option did not change the recurrence rate (12% (95% CI, 9%–15%)) or heterogeneity. Funnel plot assessment revealed no publication bias. LIMITATIONS: There were no randomized controlled trials available. The statistical heterogeneity was moderate (I 2 = 46%). CONCLUSIONS: Nonoperative management of Hinchey I/II right-sided diverticulitis is safe and feasible. The recurrence rate is relatively low, and complications that require urgent operation are uncommon. PROSPERO: CRD42019131673

Background Adoption of minimally invasive approaches continues to increase, and there is a need to reassess outcomes and cost. We aimed to compare open versus minimally invasive colectomy short- and long-term health-care utilization and payer/patient expenditures for benign disease. Methods This is a retrospective analysis of IBM® MarketScan® Database patients who underwent left or right colectomy for benign disease between 2013 and 2018. Outcomes included total health-care expenditures, resource utilization, and direct workdays lost up to 365 days following colectomy. The open surgical approach (OS) was compared to minimally invasive colectomy (MIS) with subgroup analysis of laparoscopic (LS) and robotic (RS) approaches using inverse probability of treatment weighting. Results Of 10,439 patients, 2531 (24.3%) had open, 6826 (65.4%) had laparoscopic, and 1082 (10.3%) had robotic colectomy. MIS patients had shorter length of stay (LOS; mean difference, − 1.71, p < 0.001) and lower average total expenditures (mean difference, − $2378, p < 0.001) compared with open patients during the index hospitalization. At 1 year, MIS patients had lower readmission rates, and fewer mean emergency and outpatient department visits than open patients, translating into additional savings of $5759 and 2.22 fewer days missed from work for health-care visits over the 365-day post-discharge period. Within MIS, RS patients had shorter LOS (mean difference, − 0.60, p < 0.001) and lower conversion-to-open rates (odds ratio, 0.31 p < 0.001) during the index hospitalization, and lower hospital outpatient visits (mean difference, − 0.31, p = 0.001) at 365 days than LS. Conclusion MIS colectomy is associated with lower mean health-care expenditures and less resource utilization compared to the open approach for benign disease at index operation and 365-days post-discharge. Health-care expenditures for LS and RS are similar but shorter mean LOS and lower conversion-to-open surgery rates were observed at index operation for the RS approach.

We present a patient with perforated diverticulitis contained within an inguinal hernia sac—a diagnostic and treatment dilemma. A 61-year-old man presented to the emergency department with left testicular and groin pain, and loose stool. CT imaging showed a left inguinal hernia containing a perforated segment of sigmoid colon. A segmental sigmoidcolectomyy and end colostomy Hartmannn’s procedure) was performed after reducing the incarcerated inguinal contents. The inguinal hernia was not repaired because of faecal contamination of the hernia sac and risk for recurrence. Pathological examination of theresectedd bowel specimen showed perforated sigmoid diverticulitis in an inguinal hernia sac. The patient had an uneventful recovery and is awaiting definitive inguinal hernia repair andtakedownn of his colostomy.

A man in his 70s presented with acute sigmoid diverticulitis complicated by a large pericolonic abscess abutting the left rectus abdominis muscle. He was admitted for non-operative management. On hospital day 2, he developed haemorrhagic shock from profuse haematochezia. Colonoscopy was not advisable in the setting of acute complicated diverticulitis. Placement of a percutaneous drain into the abscess cavity returned bright red blood, which was concerning for erosion of the diverticular abscess into the left inferior epigastric artery. An urgent diagnostic angiogram showed hyperaemia enveloping the abscess cavity. Haemostasis was achieved by angioembolisation of the left inferior epigastric artery. The patient did well and was discharged with a course of antibiotics in anticipation of an elective sigmoidectomy.

No abstract