Laparoscopic treatment for acute diverticular disease

Abstract

Diverticular disease of the sigmoid colon involves more than 50% of population over 60 years, and much more in people older than 80 years. Most patients remain asymptomatic, but, about 10-20% develop complications requiring surgery. Colonic diverticulitis represents an acute bowel inflammation, in many cases, confined only to the sigmoid and descending colon. Recurrent attacks and complications of diverticulitis require surgical procedure, although most cases can be managed medically. The cause of acute diverticulitis remains obscure. It has been speculated that obstruction at the mouth of the diverticulum results in diverticulitis, similar to appendicitis, but this is no longer the accepted theory, and some feel that chronic inflammation precedes clinical diverticulitis.

Sigmoid resection for diverticular disease – to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta‐analysis

“…The methodological evaluation of the non‐RCTs with the MINORS scale showed that two studies scored 21 points (high quality) , two had 17 points and the other two studies scored 10 points (poor quality) (Appendix ). In the non‐RCTs there was a possible selection bias associated with the decision to preserve or to ligate the IMA.…”

“…The electronic search strategy identified 145 citations. After the initial screening of the titles and abstracts and removal of duplications, 58 titles remained, of which 15 were considered relevant [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. A total of eight studies met the inclusion criteria and were included in the analysis [16][17][18][19][20][21][22][23] and seven studies were excluded [24][25][26][27][28][29][30] (see Appendix S1 in the online Supporting Information).…”

“…These recent techniques are very different from Valdoni's technique performed by Tocchi et al . and Pignata and are technically easier – the dissection is performed peripherally in the sigmoid mesocolon (at the level of the sigmoid vessels or close to the colon). Keighley reported that ‘it is probably safer to divide the vessels peripherally rather than attempt a high pedicle ligation; hence the superior haemorrhoidal vessels are preserved’ .…”

“…Authors and year of publication Type of study (poor quality) [21,22] (Appendix S3). In the non-RCTs there was a possible selection bias associated with the decision to preserve or to ligate the IMA.…”

“…There was heterogeneity regarding the inclusion/exclusion criteria: three studies excluded the emergency setting [17,18,23] whereas in the other studies [19][20][21][22] some of the included patients had emergency resections (Appendix S5). The definition of anastomotic leakage (clinical versus radiological) was reported in five studies (Appendix S6).…”