Intracorporeal vs laparoscopic-assisted resection for uncomplicated diverticulitis of the sigmoid

Background: Minimally invasive surgery for uncomplicated diverticulitis of the sigmoid (UDS) may be performed either as an intracorporeal procedure (LICR) or as laparoscopically assisted colon resection (LACR). Methods: Prospectively collected data of 40 selected patients who had undergone LICR for UDS between 1992 and 1994 were compared retrospectively with those of 34 diagnosis-matched LACR controls operated on at the same hospital between 1995 and 1996 to assess the short-term outcome. Results: There were no mortalities. LICR and LACR patients were well matched for age, gender, weight, American Society of Anesthesiologists (ASA) grade, duration of symptoms, and number of previous admissions. There were no significant differences in conversions (one vs three), mobilization of splenic flexure (11:29 vs 9:25), anastomotic distance from anal verge (12 vs 13 cm), estimated blood loss (270 vs 285 ml), passage of flatus (3.1 vs 3.8 days), operating room (OR) costs ($3,040 vs $2,820), and total hospital costs ($9,250 vs $10,050) in LICR and LACR patients, respectively. Suprapubic skin-incision length (36 vs 60 mm, p << 0.01), size of circular stapler 28:31 mm (1:39 vs 6:28, p = 0.03), specimen length (21 vs 11 cm, p << 0.01), complication rates (6 vs 5, p = 0.02), OR time (180 vs 244 min, p < 0.001), resumption of oral solid food intake (3.2 vs 5.8 days, p < 0.001), hospital stay (4.6 vs 9.9 days, p < 0.001), and ward costs ($2,360 vs $4,950, p < 0.001) were significantly different in LICR and LACR patients, respectively. Conclusion: The immediately recognizable advantages of LICR over LACR surmised from this study need further evaluation in a prospective randomized setting. LICR remains a procedure of considerable technical complexity requiring high surgical skills.