Laparoscopic Versus Open Emergent Sigmoid Resection for Perforated Diverticulitis

Lee, Yongjin F; Brown, Rebecca; Battaglia, Michael A; Cleary, Robert K.

doi:10.1007/s11605-019-04490-9

Cited by 21 publications

(11 citation statements)

References 54 publications

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“…For some reason there has not been the same enthusiasm for miniinvasive surgery in emergency settings even though presumably the same advantages in favour of laparoscopy could potentially apply. Previous studies cautiously recommend wider use of laparoscopy but as mentioned earlier, they are all retrospective, most single-center studies with small numbers of patients 18,24,[36][37][38][39][40][41][42] shown that laparoscopy induces negative effects on peritoneal integrity, modi es its immune system, and induces peritoneal acidosis 43 .…”

Section: Discussionmentioning

confidence: 99%

“…In retrospective studies, comparing two different techniques, selection bias is inevitable. Some register-based studies have tried to balance the open and laparoscopic groups by propensity score methods18,24,[36][37][38][39][40][41][42] . However, these studies still have remarkable limitations such as retrospective nature of the study, data loss, nonuniformity, selection bias, and coding errors.There are many possible risk factors which can be attributed to laparoscopic emergency colorectal surgery, like iatrogenic bowel perforations, inadequately performed abdominal lavage, risk for contamination and poor decompression.…”

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confidence: 99%

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LapEmerge-trial: laparoscopic approach for emergent colon resection; a multicentre, open label, randomized controlled trial.

Grönroos-Korhonen,

Kössi

2023

Preprint

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Background Because of faster recovery and less morbidity, laparoscopy has become the golden standard in elective colorectal surgery both for benign and malignant disease. A substantial portion of colorectal surgery is however carried out in emergency settings and most of the emergency resections are still performed open. The aim of this study is to compare laparoscopic versus open approach for emergency colorectal surgery. Method/Design This is a multicenter prospective randomized controlled trial including adult patients presenting with a condition requiring emergency colorectal resection. Discussion Previous studies cautiously recommend wider use of laparoscopy in emergency colorectal resections, but all earlier reports are retrospective, mostly single center studies and have limited number of patients. There might be unpredictable risks with laparoscopy yet not reported because of infrequent use of the technique. A prospective randomized controlled trial is urgently needed to assess the safety of laparoscopy as well as advantages and disadvantages between open and laparoscopic emergency surgery. Trial registration number: NCT05005117, URL: https://trialsearch.who.int/Trial2.aspx?TrialID=NCT05005117

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

LapEmerge-trial: laparoscopic approach for emergent colon resection; a multicentre, open label, randomized controlled trial.

Grönroos-Korhonen,

Kössi

2023

Preprint

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“…Laparoscopic sigmoid resection excels the open sigmoid resection for complicated acute diverticulitis in terms of morbidity and hospitalization [ 39 , 40 ]. Laparoscopic treatment is recommended for the management of many other intraperitoneal inflammations [ 41 ].…”

Section: Reviewmentioning

confidence: 99%

Current Aspects on the Management of Perforated Acute Diverticulitis: A Narrative Review

Pavlidis¹,

Pavlidis²

2022

Cureus

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Unhealthy nutritional habits and the current western lifestyle have led to an increased incidence of acute diverticulitis, which mainly affects older patients. However, the disease course in younger patients might be more severe. It has a continued increase in surgical practice, as it is the most common clinical condition encountered in the emergencies. Diagnosis and management have changed over the past decade. C-reactive protein > 170 mg/L represents the cut-off point between moderate and severe diverticulitis, and a CT scan is mandatory. It demands urgent surgical management and has high morbidity and mortality rate, especially in immunosuppressed patients, reaching up to 25%. According to the contemporary guidelines, there have been certain indications for conservative management and re-evaluation (administration of antibiotics, CT-guided drainage of the abscess, when it is > 4 cm). They include pericolic air bubbles or a small amount of fluid, absence of abscess within a distance of 5 cm from the affected bowel or abscess ≤4 cm. In other cases, Hartmann’s sigmoidectomy is the procedure of choice. An alternative choice, nowadays, is resection and primary anastomosis with or without diverting stoma, especially in younger patients. Laparoscopic lavage only versus primary resection has been performed in severe cases of Hinchey III or IV. Damage control surgery, possible open abdomen, and reoperation are recommended in severe sepsis. Hinchey’s classification may not be absolutely adequate, and several modifications have been proposed. Current classification criteria (CRP, qSOFA score) are more appropriate. The decision-making must be individualized depending on the hemodynamic status (septic shock), age, comorbidity, immune status, intraoperative findings, and MPI (Mannheim peritonitis index).

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“…A relatively more recent trend in surgical research has been questioning the appropriateness of laparoscopic sigmoid resections in emergent diverticulitis cases, as opposed to the traditional open operation. Retrospective reviews have been promising in favor of the laparoscopic approach, though these (despite attempts at propensity scoring) still suffer from the selection bias of older and more comorbid patients receiving open operations, and intention-to-treat analyses despite high conversion rates to open procedures [ 54 - 56 ]. No RCT has yet been performed on this topic.…”

Section: Management Of Complicated Diverticulitismentioning

confidence: 99%

Emerging evidence and recent controversies in diverticulitis: a 5-year review

Koprowski¹

2021

aog

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Diverticulitis is a common gastrointestinal disease that still garners significant attention and study because of its heterogeneity in presentation and outcome. We provide a review of the newest and most controversial topics in diverticulitis. Recent discoveries on the influence of diet and other environmental risk factors are discussed, showing how the epidemiology of the disease process is shifting away from what was previously felt to be a disorder primarily limited to older western populations. Interestingly, as has long been suspected, genetic mutations and variations associated with the development of diverticulitis are being discovered and are summarized here. The data for non-operative and outpatient management of diverticulitis are reviewed, as are pharmacologic agents studied for use in the secondary prevention of diverticulitis. Lastly, we present controversies in the surgical treatment of diverticulitis. This review will provide a synopsis of the last 5 years of literature relating to diverticulitis.

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Laparoscopic Versus Open Emergent Sigmoid Resection for Perforated Diverticulitis

Cited by 21 publications

References 54 publications

LapEmerge-trial: laparoscopic approach for emergent colon resection; a multicentre, open label, randomized controlled trial.

LapEmerge-trial: laparoscopic approach for emergent colon resection; a multicentre, open label, randomized controlled trial.

Current Aspects on the Management of Perforated Acute Diverticulitis: A Narrative Review

Emerging evidence and recent controversies in diverticulitis: a 5-year review

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