Laparoscopic sigmoid resection for diverticulitis: is learning phase associated with increased morbidity?

Aim. - To assess retrospectively the results of laparoscopic sigmidectomy for diverticulitis, with intent to treat, in 58 consecutive patients operating by one surgeon compared with a control group operating by laparotomy. Materials and methods. - From 1995 to 2001, 90 consecutive patients undergoing elective sigmoid resection for diverticulitis were divided into 3 groups : laparotomy (Group 1 : n = 32), first cases of laparoscopy (Group 2 : n = 29) and last cases of laparoscopy (Group 3 : n = 29). These 3 groups were similar according to age, sex, Body Mass Index (BMI), American society of anesthesia score (ASA), previous abdominal surgery, number of attacks of diverticulitis, and time between last attack and surgery. Following criteria were studied: operating time, conversation rate, intra-operative and post-operative morbidity, return of intestinal transit, and hospital stay. Results. - During laparoscopy, conversion was mandatory in 24% of the cases (7/29) in group 2 and 14% in group 3 (4/29; NS). No intra-operative morbidity was noted in the 58 laparoscopies. Mean operative time was 240 min in group 1, 259 min in group 2, and 241 min in group 3 (NS). Postoperative morbidity was observed in 31% of patients in group 1, 34% in group 2, and 10% in group 3 (p = 0.02). Returm of intestinal transit and oral ingestion and mean hospital stay were significantly shorter in group 2 and group 3 versus group 1 (p < 0.05). Conclusion. - Our results confirm previous data demonstrating faisability of laparoscopic sigmodectomy for diverticulitis and its benefice in terms of return of intestinal transit and hospital stay. Furthermore, our study suggest that when surgeon gain experience, conversion rate, morbidity and operative time can be reduced. (C) 2003 Editions scientifiques et medicales Elsevier SAS. All rights reserved.