Colectomia eletiva laparoscópica esquerda para a doença diverticular: estudo monocêntrico sobre 205 pacientes consecutivos

Abstract

-Background -The increased prevalence of diverticular disease has made its most appropriate management a matter of constant debate. Especially for the cases of diverticulitis, considerable progress has been made in terms of diagnosis and management.The surgical resection of the involved colon is the only means of definitely eradicate this condition and so, the elective laparoscopic colectomy has emerged as a safe and interesting choice among the options of treatment. Aim -To analyze the outcomes of the laparoscopic left colectomy for diverticular disease performed over a 17-year period at a single institution. Methods -Between April 1990 and May 2007, a total of 205 consecutive left laparoscopic colectomies were retrospectively reviewed. Data obtained included the pre-operative workup, indications for surgery, operative results, complications and follow-up. Univariate and multivariate statistical analyzes were performed in an effort to identity risk factors for adverse outcomes in the series. Results -Indications were for non-complicated acute diverticulitis (80%), acute or chronic complicated diverticulitis (18.05%) and bleeding diverticular disease (1.95%). The conversion rate was 5.85% (12 cases). The median operative time was 180 (100-420) min with a hospital stay of 7 (5-44) days. The mean length of the resected specimen was 29.12 (+8.2) cm. Most cases (88.3%) had an unremarkable postoperative course but complications occurred in 24 (11.7%) patients. In order of frequency, these were: paralytic ileus (n=6), pelvic collections (n=4), bowel obstructions (n=4) and fistulas (n=2), among others. A re-operation was necessary in eight cases and there was one death (0.48%). Median follow-up was 26.5 (1-156) months with a satisfying result seen in 179 (87.32%) of the patients. In 18 (8.78%) cases, persistent symptoms of functional colonic disorders were noted. There were 7 (3.41%) anastomotic stenosis in witch two needed a re-operation. The recurrence rate was 1.95% (4 cases). Age and intraoperative complications were identified as risk factors for conversion. The presence of associated lesions was significantly correlated with the persistence of functional colonic symptoms during the follow-up. ConclusionsThe laparoscopic left colectomy is safe and effective in comparison to all other modalities of management for diverticular disease. Precise diagnosis and respect of the current indications are essential to achieve such results.RESUMO -Racional -O aumento da prevalência de doença diverticular tornou o seu manuseio mais adequado uma questão de debate constante. Especialmente para os casos de diverticulite, progresso considerável tem sido feito em termos de diagnóstico e tratamento. A ressecção cirúrgica do cólon envolvido é a única maneira de erradicar definitivamente essa condição e, portanto, a colectomia laparoscópica eletiva surgiu como uma opção segura e interessante entre as várias formas de tratamento. Objetivo -Analisar os resultados das colectomias laparoscópicas esquerdas para a doença diverticula...