Early elective versus elective sigmoid resection in diverticular disease: not only timing matters—a single institutional retrospective review of 133 patients

Abstract

Purpose The optimal timing of elective surgery in patients with the colonic diverticular disease remains controversial. We aimed to analyze the timing of sigmoidectomy in patients with diverticular disease and its influence on postoperative course with respect to the classification of diverticular disease (CDD). Methods Patients who underwent elective laparoscopic sigmoidectomy were retrospectively enrolled and subdivided into two groups based on the time interval between the last attack and surgery: group A, early elective (≤ 6 weeks), and group B, elective (> 6 weeks). Multivariate regression models were used to identify factors which predict conversion to laparotomy, postoperative course, and length of hospital stay. Results A total of 133 patients (group A (n = 88), group B (n = 45)) were included. Basic demographic data did not differ between groups except for a higher rate of diabetes in group B (p = 0.009). The conversion rate was significantly higher in group A in comparison to group B (group A vs. group B: n = 23 (26.1%) vs. n = 3 (6.7%), p = 0.007). Logistic regression analysis revealed the timing of surgery and CDD stage as significant predictors for intraoperative conversion. Moreover, the postoperative course was influenced by high age as well as intraoperative conversion and length of hospital stay by conversion, preoperative CRP levels, and elective surgery. Conclusions Both, timing of surgery and the disease stage, influence the conversion rates in laparoscopic sigmoidectomy for diverticular disease. Accordingly, patients with complicated acute or chronic sigmoid diverticulitis should be operated in the inflammation-free interval.

Surgical management in immunosuppressed patients with sigmoid diverticulitis, still a challenge: a single-center observational study

“…Elective surgery was performed either within 6 weeks after the acute attack (early elective) or after 6 weeks in the inflammation-free interval (delayed elective) The surgical approach (open vs. laparoscopic) was primarily determined based on the severity of the diverticular disease stage, the clinical condition of the patient and contraindications of laparoscopic surgery and secondly at the discretion of the involved surgeon. The technique of laparoscopic sigmoid resection was described in our previous study [26]. Patients with fecal or purulent contamination and severe sepsis underwent damage control sigmoidectomy and subsequent second or third look procedures if necessary.…”

The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis

“…The initial database research with the previously defined keywords identified 2347 potentially relevant abstracts. Of these, 17 full-text articles were assessed for eligibility and finally, 11 studies (8 retrospective and 3 prospective non-randomized cohort studies) comparing the outcome of operative timing in sigmoid diverticular disease were included in the qualitative and quantitative data analysis [26][27][28][29][30][31][32][33][34][35][36]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for the literature search is depicted in Fig.…”

“…Notably, the distribution of sigmoid diverticular disease stages throughout the analyzed studies is not homogenous. While some authors [33,34] exclude cases with complicated disease stages, others [28,[30][31][32]36] mixed cases with chronic or complicated and noncomplicated sigmoid diverticulitis. The hereby presented results must be cautiously interpreted as all the included and analyzed studies are nonrandomized with the limited methodical quality attributed to observational cohort studies.…”

“…Over an enrollment period from 2003 to 2021, the 11 included studies from six different countries (USA, Egypt, Switzerland, Austria, and Germany) reported their outcomes of primary minimally invasive sigmoidectomy in the early elective and delayed elective setting. All studies excluded patients with free perforation and peritonitis or patients within septic conditions prior to surgery [26][27][28][29][30][31][32][33][34][35][36]. Other exclusion criteria were initial open surgical approach and previous abdominal surgery.…”

“…Conversion rate as the primary endpoint was reported for all 2096 patients in the 11 included studies without exception [26][27][28][29][30][31][32][33][34][35][36] (Fig. 3a).…”