Laparoscopy for Diverticular Disease

Laparoscopic colectomy has been demonstrated a safe technique in patients with colon and rectal cancer.

Up to 25% of people with diverticulosis will develop diverticulitis with morbidity approaching 60% for those with recurrent attacks. The goal for operative management of diverticular disease is to electively resect the at-risk colon before an emergent colostomy is required. The question of whether to approach these elective operations laparoscopically or open remains controversial.

Randomized controlled trials including COST, COLOR and CLASICC have reinforced the safety of this approach in patients with cancer. Diverticular disease poses unique challenges, though, given the inherent inflammatory changes associated with the disease.

In 2009, results of the SIGMA trial were published; a multi-center, randomized controlled trial of laparoscopic versus open elective operation for diverticular disease. This study found a significantly decreased length of hospital stay, less post-operative pain and a better quality of life after laparoscopic operation. Additionally, a 15.4% reduction in major complications (leak, bleeding, myocardial infarction and pulmonary emboli) was found in the laparoscopic group. A 2010 meta-analysis of available literature similarly demonstrated a decrease in complications with laparoscopic operation.

As surgeon and institutional experience with laparoscopic colectomy expand, continued reduction in complication and conversion rates can be expected. Further, as comfort with more advanced minimally invasive approaches such as single incision laparoscopic surgery increases, adaptation of these procedures may increase as well.

Dr. Jeremy Lipman, colorectal surgeon, has joined MetroHealth Medical Center and is accepting new patients. Dr. Lipman specializes in utilizing single-incision laparoscopic techniques on a full range of conditions including Crohn’s disease, ulcerative colitis and cancer.

SOURCE: mdnews