Anastomosis level and specimen length in surgery for uncomplicated diverticulitis of the sigmoid

Background: Extent of bowel resection and level of anastomosis are unsettled issues of surgery for diverticulitis of the sigmoid. The aim of this study was to compare the adequacy of open colon resection (OCR) with that of laparoscopic colon resection (LCR) for uncomplicated diverticulitis of the sigmoid (UDS), specifically addressing level of anastomosis and length of specimen. Methods: Comparisons were made between 40 selected patients undergoing LCR for UDS between 1992 and 1994 and 35 diagnosis-matched controls who previously underwent OCR by the same surgeons at the same institution. Results: The OCR and LCR patients were well-matched for age, gender, weight, ASA grade, duration of symptoms, and number of previous admissions. There were no significant differences, respectively, between OCR and LCR patients in morbidity rates (2 vs. 5, p = 0.33) and rates of mobilization of the splenic flexure (17:18 vs. 29:11, p < 0.1). Specimen length (18 cm vs. 11 cm, p much less than 0.01), colosigmoid vs. colorectal anastomosis (24:11 vs. 1:39, p much less than 0.01), and presence of inflammatory cells at the proximal resection margin (2 vs. 11, p = 0.02) were significantly different. The OCR patients had statistically longer follow-up than LCR patients (63 months vs. 46 months, p much less than 0.01). Recurrent diverticulitis rates were 9.6% and 2.7% after OCR and LCR, respectively (3 vs. 1, p = 0.73). Conclusions: Inadequate sigmoid resection should prompt diligence to take down the splenic flexure placing the distal anastomotic margin on the rectum to ensure adequate surgery.