Re-establish pneumoperitoneum in laparoscopic-assisted sigmoid resection? Randomized trial.

PURPOSE: Operating room time and anastomosis-related morbidity of laparoscopic-assisted sigmoid resection with anastomosis performed in an open fashion through a horizontal suprapubic incision or laparoscopically after re-establishing pneumoperitoneum were compared.

METHODS

A randomized trial was performed on patients with recurrent uncomplicated diverticulitis of the sigmoid colon during a 14-month period. Inclusion criteria were persistence of symptoms despite medical treatment and two previous admissions. Exclusion criteria included complicated diverticulitis, suspected cancer, and previous extensive abdominal surgery. Because skin incisions were similar and patients were randomly assigned in the operating room, the trial was performed as double blind.

RESULTS

There were no deaths. Two patients were excluded before randomization. Three patients were not treated as allocated because of conversion to open surgery. Aside from previous abdominal-surgery rates, 16 patients with laparoscopic-assisted sigmoid resections after re-establishing pneumoperitoneum and 15 patients with laparoscopic-assisted sigmoid resections with anastomosis performed in an open fashion through a horizontal suprapubic incision were well-matched for age, gender, weight, American Society of Anesthesiology class, previous admissions, skin-incision length, size of circular stapler, and mobilization of splenic flexure. There were no significant differences in morbidity rates (3/16 vs. 3/15), complete doughnuts (16/16 vs. 15/15), blood loss (300 vs. 200 ml), flatus (4 vs. 4 days), solid-food resumption (5 vs. 6 days), stay (8.5 vs. 9 days) in laparoscopic-assisted sigmoid resection after re-establishing pneumoperitoneum and laparoscopic-assisted sigmoid resection with anastomosis performed in an open fashion through a horizontal suprapubic incision groups, respectively. Patients with laparoscopic-assisted sigmoid resection after re-establishing pneumoperitoneum had statistically longer operating room time (295 vs. 190 minutes; P < 0.01). Median follow-up was 12 and 10 months in 10 patients with laparoscopic-assisted sigmoid resection after re-establishing pneumoperitoneum and 11 patients with laparoscopic-assisted sigmoid resection with anastomosis performed in an open fashion through a horizontal suprapubic incision, respectively. One patient with laparoscopic-assisted sigmoid resection with anastomosis performed in an open fashion through a horizontal suprapubic incision had an anastomotic stenosis endoscopically dilated.

CONCLUSIONS

Nonrestoration of pneumoperitoneum after laparoscopic-assisted sigmoid resection allows a decrease in operating room time and a similar outcome.