A comparison of laparoscopic, hand-assist and open sigmoid resection in the treatment of diverticular disease - Discussion

Background: Laparoscopic colorectal surgery (LAP) has become more prevalent as evidence of its safety and benefits become apparent. However, in difficult cases, hand-assisted instrumentation has facilitated LAP. We examined the impact of hand-assisted laparoscopic surgery (HALS) on the treatment of sigmoid diverticular disease. Methods: This is a retrospective study using a prospectively maintained database from January 1, 2000 through November 30, 2005. Patients were divided into 3 groups: open (n = 110), LAP (n = 17), and HALS (n = 98). Data include operative time, length of stay, surgical method, conversion rate, and reasons for conversion. Results: Surgeries started as LAP were completed in that fashion 59% of the time, with 23% being converted to open and 18% converted to HALS (total 41%). HALS cases showed a 6% conversion rate to open surgery (OS). Duration of surgery and length of stay were similar between LAP and HALS. Conclusions: HALS should be considered the optimal approach for surgery for diverticular disease. © 2007 Excerpta Medica Inc. All rights reserved.