Laparoscopy decreases anastomotic leak rate in sigmoid colectomy for diverticulitis.

BACKGROUND

Early studies comparing laparoscopic and open operations for diverticulitis failed to show any advantages of the laparoscopic approach. Our study compared the 30-day postoperative outcomes of laparoscopic and open sigmoid colectomy for diverticulitis by surgeons who had performed 20 or more laparoscopic colectomies before the study period.

HYPOTHESIS: Patients who undergo an elective laparoscopic operation for diverticulitis have reduced postoperative complications compared with patients who have a traditional open operation.

DESIGN

Retrospective analysis.

SETTING

Academic medical center.

PATIENTS: A total of 249 patients who underwent elective open (n = 127) or laparoscopic (n = 122) sigmoid colectomy with primary anastomosis for diverticulitis between July 1, 2001, and February 1, 2008.

MAIN OUTCOME MEASURES: Combined rates of free and contained anastomotic leaks. A logistic regression model was used to determine predictors of anastomotic leaks while controlling for significant differences between study groups.

RESULTS

Patients who underwent laparoscopic or open operations were similar in age, sex, history of diagnosed intraabdominal abscess (9.4% vs 12.3%), and history of preoperative percutaneous abscess drainage (3.9% vs 4.9%). Patients who underwent the open procedure had a higher Charlson comorbidity index (1.6 vs 1.2; P = .04), and those who underwent laparoscopy more frequently underwent splenic flexure mobilization (82.8% vs 26.7%; P < .001). Patients who underwent a laparoscopy had lower rates of anastomotic leaks (2.4% vs 8.2%; P = .04). This finding held true on logistic regression analysis (odds ratio, 0.67; 95% confidence interval, 0.008-0.567; P = .01), even when controlling for age, Charlson comorbidity index, splenic flexure mobilization, and length of resected bowel.

CONCLUSION

Anastomotic leaks occurred less frequently after laparoscopic sigmoid colectomy performed by experienced laparoscopic colorectal surgeons.