Sind eine laparoskopische Diskontinuitätsresektion und eine spätere laparoskopische Rekonstruktion bei der komplizierten Sigmadivertikulitis möglich?

Abstract

Surgery of complicated sigmoid diverticulitis should be as gentle as possible. Serious time pressure, unpredictable operation fields and unprepared bowel determine the surgical strategy. Hence, we examine whether minimal invasive surgery (MIS) (i. e., Hartmann procedure) is suited for emergency conditions in selected patients. Furthermore, the objective of the study was to -assess the feasibility of the reversal of Hartmann procedure in appropriate patients after a preceding classical or laparoscopic intervention. -Between 2005 and 2009 128 patients with sigma diverticulitis were operated, 72 patients of them with complicated sigmoid diverticulitis (peritonitis, haemorrhage, ileus, perforation), The classical Hartmann procedure was performed in 45 (35 %) patients, 39 of them being treated within 24 hours. The laparoscopically assisted Hartmann procedure was realised in 15 patients and could be successfully completed in 13 cases. The cor-responding mortality rate was 0 %. A Hartmann reversal could be performed in 26 patients (58 %). A laparoscopic approach was chosen in 16 patients and could be successfully completed in 14 cases. 12 patients were operated with classical Hartmann reversal. The respective mortality rates in both groups were 0 %. We therefore conclude that in cases of peritonitis due to sigmoid diverticulitis laparoscopic surgery, like laparoscopically assisted Hartmann procedure and a subsequent laparoscopically assisted reversal could be recommended in selected patients.

Laparoscopic Versus Open Hartmann Procedure for the Emergency Treatment of Diverticulitis

“…7,8 The primary objective of this study was to determine whether the addition of laparoscopy to the Hartmann's procedure would decrease postoperative morbidity and mortality for treatment of complicated diverticulitis. On univariate analyses of the entire study cohort, the laparoscopic group had a significantly decreased overall complication rate and a shorter hospitalization, which was consistent with previous studies comparing laparoscopic and open approaches in elective surgery for diverticulitis.…”

“…1 Due to the high complication and mortality rates associated with this approach, 2-6 the addition of laparoscopy to the Hartmann's procedure has been proposed to reduce the incidence of postoperative complications and expedite recovery. 7,8 …”

Operationsindikation bei Divertikulitis – Gibt es neue Daten?

“…Vor dem Hintergrund der demografischen Entwicklung tritt diese Situation in der Realität eines Versorgungskrankenhauses jedoch eher häufiger ein. Auch im Notfall einer Diskontinuitätsresektion ist die Operation bei geeigneten Patienten laparoskopisch machbar[38]. Letztlich kann die Entscheidung über das Vorgehen immer nur individuell als Synthese aus Allgemeinzustand und Komorbidität des Patienten, Stadium der Peritonitis und Sepsis sowie ganz besonders der Erfahrung des Operateurs getroffen werden.…”