Laparoscopic resection of sigmoid diverticulitis

Köckerling, F.; Schneider, Claus; Reymond, Marc A.; Scheidbach, H.; Scheuerlein, H.; Konradt, J.; Bruch, Hans–Peter; Zornig, C.; Köhler, L.; Bärlehner, E.; Kuthe, A.; Szinicz, G.; Richter, H. A.; Hohenberger, W.

doi:10.1007/s004649901042

Cited by 180 publications

(95 citation statements)

References 12 publications

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“…Em publicação de 1999, Kockerling et al 32 reportaram que a DDC representou 27% das indicações dentre 1118 pacientes operados em diversos países europeus. De forma semelhante, uma pesquisa patrocinada pelas Sociedades Americanas de Cirurgia Endoscópica e Cirurgia Colorretal mostrou que 74% dos cirurgiões indicam vídeo-cirurgia para pacientes com DDC 33 .…”

Section: Discussionunclassified

Resultados do registro nacional brasileiro em vídeo-cirurgia colorretal - 2007

Valarini¹,

Campos

2008

Rev bras. colo-proctol.

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Section: Discussionunclassified

Resultados do registro nacional brasileiro em vídeo-cirurgia colorretal - 2007

Valarini¹,

Campos

2008

Rev bras. colo-proctol.

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“…Reported failure rates for diverticular abscesses range from 15% to 30% [11][12][13], and when PAD fails, the mortality rate may be as high as 75% [14]. Third, when drainage is feasible and initially successful, abscess recurrence or fistula may occur, compromising the performance of an elective surgical resection [15].…”

mentioning

confidence: 99%

Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan

et al. 2006

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Background: Percutaneous abscess drainage guided by computed tomography scan is considered the initial step in the management of patients presenting with Hinchey II diverticulitis. The rationale behind this approach is to manage the septic complication conservatively and to follow this later using elective sigmoidectomy with primary anastomosis. Methods: The clinical outcomes for Hinchey II patients who underwent percutaneous abscess drainage in our institution were reviewed. Drainage was considered a failure when signs of continuing sepsis developed, abscess or fistula recurred within 4 weeks of drainage, and emergency surgical resection with or without a colostomy had to be performed. Results: A total of 34 patients (17 men and 17 women; median age, 71 years; range, 34-90 years) were considered for analysis. The median abscess size was 6 cm (range, 3-18 cm), and the median duration of drainage was 8 days (range, 1-18 days). Drainage was considered successful for 23 patients (67%). The causes of failure for the remaining 11 patients included continuing sepsis (n = 5), abscess recurrence (n = 5), and fistula formation (n = 1). Ten patients who failed percutaneous abscess drainage underwent an emergency Hartmann procedure, with a median delay of 14 days (range, 1-65 days) between drainage and surgery. Three patients in this group (33%) died in the immediate postoperative period. Among the 23 patients successfully drained, 12 underwent elective sigmoid resection with a primary anastomosis. The median delay between drainage and surgery was 101 days (range, 40-420 days). In this group, there were no anastomotic leaks and no mortality. Conclusion: Drainage of Hinchey II diverticulitis guided by computed scan was successful in two-thirds of the cases, and 35% of the patients eventually underwent a safe elective sigmoid resection with primary anastomosis. By contrast, failure of percutaneous abscess drainage to control sepsis is associated with a high mortality rate when an emergency resection is performed. The current results demonstrate that percutaneous abscess drainage is an effective initial therapeutic approach for patients with Hinchey II diverticulitis, and that emergency surgery should be avoided whenever possible.

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“…The approach is usually open, because the laparoscopic procedure is burdened by a high conversion rate and morbidity [13]. Only few cases of laparoscopic treatment of colovesical fistula are reported in literature [13][14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…Generally, internal fistulas that complicate diverticulitis are associated with high conversion rates and post-operative morbidity, resulting from close adhesions as well as insufficient surgical experience [16,18,[21][22][23]. However, several recent series have reported acceptable conversion rates [24].…”

Section: Discussionmentioning

confidence: 99%