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Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort

BACKGROUND: Hartmann’s procedure for perforated diverticulitis can be characterised by high morbidity and mortality rates. While the scientific community focuses on laparoscopic lavage as an alternative for laparotomy, the option of laparoscopic sigmoidectomy seems overlooked. We compared morbidity...

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Autores principales: Vennix, Sandra, Lips, Daniel J., Di Saverio, Salomone, van Wagensveld, Bart A., Brokelman, Walter J., Gerhards, Michael F., van Geloven, Anna A., van Dieren, Susan, Lange, Johan F., Bemelman, Willem A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4992031/
https://www.ncbi.nlm.nih.gov/pubmed/26679173
http://dx.doi.org/10.1007/s00464-015-4694-8
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author Vennix, Sandra
Lips, Daniel J.
Di Saverio, Salomone
van Wagensveld, Bart A.
Brokelman, Walter J.
Gerhards, Michael F.
van Geloven, Anna A.
van Dieren, Susan
Lange, Johan F.
Bemelman, Willem A.
author_facet Vennix, Sandra
Lips, Daniel J.
Di Saverio, Salomone
van Wagensveld, Bart A.
Brokelman, Walter J.
Gerhards, Michael F.
van Geloven, Anna A.
van Dieren, Susan
Lange, Johan F.
Bemelman, Willem A.
author_sort Vennix, Sandra
collection PubMed
description BACKGROUND: Hartmann’s procedure for perforated diverticulitis can be characterised by high morbidity and mortality rates. While the scientific community focuses on laparoscopic lavage as an alternative for laparotomy, the option of laparoscopic sigmoidectomy seems overlooked. We compared morbidity and hospital stay following acute laparoscopic sigmoidectomy (LS) and open sigmoidectomy (OS) for perforated diverticulitis. METHODS: This retrospective cohort parallel to the Ladies trial included patients from 28 Dutch academic or teaching hospitals between July 2010 and July 2014. Patients with LS were matched 1:2 to OS using the propensity score for age, gender, previous laparotomy, CRP level, gastrointestinal surgeon, and Hinchey classification. RESULTS: The propensity-matched cohort consisted of 39 patients with LS and 78 patients with OS, selected from a sample of 307 consecutive patients with purulent or faecal perforated diverticulitis. In both groups, 66 % of the patients had Hartmann’s procedure and 34 % had primary anastomosis. The hospital stay was shorter following LS (LS 7 vs OS 9 days; P = 0.016), and the postoperative morbidity rate was lower following LS (LS 44 % vs OS 66 %; P = 0.016). Mortality was low in both groups (LS 3 % vs OS 4 %; P = 0.685). The stoma reversal rate after Hartmann’s procedure was higher following laparoscopy, with a probability of being stoma-free at 12 months of 88 and 62 % in the laparoscopic and open groups, respectively (P = 0.019). After primary anastomosis, the probability of reversal was 100 % in both groups. CONCLUSIONS: In this propensity score-matched cohort, laparoscopic sigmoidectomy is superior to open sigmoidectomy for perforated diverticulitis with regard to postoperative morbidity and hospital stay. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00464-015-4694-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-49920312016-09-06 Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort Vennix, Sandra Lips, Daniel J. Di Saverio, Salomone van Wagensveld, Bart A. Brokelman, Walter J. Gerhards, Michael F. van Geloven, Anna A. van Dieren, Susan Lange, Johan F. Bemelman, Willem A. Surg Endosc Article BACKGROUND: Hartmann’s procedure for perforated diverticulitis can be characterised by high morbidity and mortality rates. While the scientific community focuses on laparoscopic lavage as an alternative for laparotomy, the option of laparoscopic sigmoidectomy seems overlooked. We compared morbidity and hospital stay following acute laparoscopic sigmoidectomy (LS) and open sigmoidectomy (OS) for perforated diverticulitis. METHODS: This retrospective cohort parallel to the Ladies trial included patients from 28 Dutch academic or teaching hospitals between July 2010 and July 2014. Patients with LS were matched 1:2 to OS using the propensity score for age, gender, previous laparotomy, CRP level, gastrointestinal surgeon, and Hinchey classification. RESULTS: The propensity-matched cohort consisted of 39 patients with LS and 78 patients with OS, selected from a sample of 307 consecutive patients with purulent or faecal perforated diverticulitis. In both groups, 66 % of the patients had Hartmann’s procedure and 34 % had primary anastomosis. The hospital stay was shorter following LS (LS 7 vs OS 9 days; P = 0.016), and the postoperative morbidity rate was lower following LS (LS 44 % vs OS 66 %; P = 0.016). Mortality was low in both groups (LS 3 % vs OS 4 %; P = 0.685). The stoma reversal rate after Hartmann’s procedure was higher following laparoscopy, with a probability of being stoma-free at 12 months of 88 and 62 % in the laparoscopic and open groups, respectively (P = 0.019). After primary anastomosis, the probability of reversal was 100 % in both groups. CONCLUSIONS: In this propensity score-matched cohort, laparoscopic sigmoidectomy is superior to open sigmoidectomy for perforated diverticulitis with regard to postoperative morbidity and hospital stay. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00464-015-4694-8) contains supplementary material, which is available to authorized users. Springer US 2015-12-17 2016 /pmc/articles/PMC4992031/ /pubmed/26679173 http://dx.doi.org/10.1007/s00464-015-4694-8 Text en © The Author(s) 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Article
Vennix, Sandra
Lips, Daniel J.
Di Saverio, Salomone
van Wagensveld, Bart A.
Brokelman, Walter J.
Gerhards, Michael F.
van Geloven, Anna A.
van Dieren, Susan
Lange, Johan F.
Bemelman, Willem A.
Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort
title Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort
title_full Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort
title_fullStr Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort
title_full_unstemmed Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort
title_short Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort
title_sort acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4992031/
https://www.ncbi.nlm.nih.gov/pubmed/26679173
http://dx.doi.org/10.1007/s00464-015-4694-8
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