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1.
Bastiaan R. Klarenbeek Roberto Bergamaschi Alexander A. F. A. Veenhof Donald L. van der Peet Wim T. van den Broek Elly S. M. de Lange Willem A. Bemelman Pieter Heres Antonio M. Lacy Miguel A. Cuesta 《Surgical endoscopy》2011,25(4):1121-1126
Background
The short-term results of the Sigma trial show that laparoscopic sigmoid resection (LSR) used electively for diverticular disease offers advantages over open sigmoid resection (OSR). This study aimed to compare the overall mortality and morbidity rates after evaluation of the clinical outcomes at the 6-month follow-up evaluation. 相似文献2.
Thaler K Weiss EG Nogueras JJ Arnaud JP Wexner SD Bergamaschi R 《Surgical laparoscopy, endoscopy & percutaneous techniques》2003,13(5):325-327
The aim of the study was to compare the impact of surgical access to sigmoid resection on recurrence rates in patients with uncomplicated diverticulitis of the sigmoid (UDS) at a minimum follow-up of 5 years. Recurrence after surgery was defined as left lower quadrant pain, fever, and leucocytosis with consistent CT and enema findings on admission and at 6 weeks, respectively. Outcome measures included splenic flexure mobilization, specimen length, inflammation at proximal resection margin, and presence of teniae coli at distal resection margin. Seventy-nine patients undergoing laparoscopic sigmoid resection (LSR) were compared with 79 matched controls with open sigmoid resection (OSR) operated on at 2 institutions during the same period. Patients were well matched for age, gender, body mass index, ASA grading, and symptoms duration, but not for follow-up length (81.9 versus 86.9 months, P = 0.046). Differences in rates of splenic flexure mobilization (19 versus 41, P < 0.001), specimen length (16.1 versus 18.3 cm, P = 0.048), inflammation at proximal resection margin (21 versus 4, P < 0.001), and teniae coli at distal resection margin (4 versus 53, P < 0.001) did not show an impact on recurrence rates when comparison was made between LSR and OSR. Three LSR patients and 7 OSR patients had 1 recurrence (P = 0.19). There were no significant differences in rates of flexure mobilization, specimen length, and rates of inflammation present at proximal resection margin in 10 recurring and 145 non-recurring patients. The rate of teniae coli present at distal resection margin was significantly increased in recurring patients (7 versus 43, P = 0.03). Median time of recurrence after surgery was 29 (range 18-74) months. Two of 11 recurrences occurred after 5 years. Surgical access to sigmoid resection for UDS is unlikely to have an impact on recurrence rates provided that the oral bowel end is anastomosed to the proximal rectum rather than to the distal sigmoid. 相似文献
3.
Ali Mahmoud Ahmed Abdelrahman Tarek Moahammed Omar Mohamed Mattar Esraa Mowafy Mohamed Esraa Abdelmonem Faraag Ammar Mohammed AlSafadi Kenji Hirayama Nguyen Tien Huy 《The surgeon》2018,16(6):372-383
Purpose
The surgical interventions of diverticulitis vary according to its grade and severity. There is a controversy about the best of these different surgical procedures. We aimed to systematically review and meta-analyze randomized controlled trials (RCTs) comparing outcomes and complications between different surgical approaches for acute diverticulitis and its complications.Methods
Nine electronic databases including PubMed, Scopus, and Web of Science were searched for RCTs comparing different surgical procedures for different grades of diverticulitis. The risk of bias was assessed using the Cochrane Collaboration tool. The protocol was registered in PROSPERO (CRD42015032290).Results
Outcome data were analyzed from five RCTs comparing laparoscopic sigmoid resection (LSR) (n = 247) versus open sigmoid resection (OSR) (n = 237) for treatment of acute complicated diverticulitis with minimal heterogeneity. There was no significant difference in short-term postoperative overall morbidity (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.61–1.31; P = 0.56) and long-term postoperative major morbidity (RR 0.78, 95% CI 0.46–1.31, P = 0.34). In other six RCTs compared laparoscopic lavage with resection for treatment of perforated diverticulitis with peritonitis, the postoperative mortality rate was non-significant in both short-term (RR 1.55, 95% CI 0.79–3.04; P = 0.21) and long-term (RR 0.67, 95% CI 0.29–1.58; P = 0.36) follow up.Conclusions
LSR is not superior over OSR regarding postoperative morbidity and mortality for acute symptomatic diverticulitis. Furthermore, laparoscopic lavage was proved to be as safe as resection for perforated diverticulitis with peritonitis. Further RCTs are still needed to make an accurate decision regarding these and other procedures. 相似文献4.
Thaler K Weiss EG Nogueras JJ Arnaud JP Wexner SD Bergamaschi R 《Acta chirurgica Iugoslavica》2004,51(2):45-47
The aim of the study was to compare the impact of surgical access to sigmoid resection on recurrence rates in patients with uncomplicated diverticulitis of the sigmoid (UDS) at a minimum follow-up of five years. Recurrence after surgery was defined as left lower quadrant pain, fever and leucocytosis with consistent CT and enema findings on admission and at 6 weeks, respectively. Outcome measures included splenic flexure mobilization, specimen length, inflammation at proximal resection margin and presence of teniae coli at distal resection margin. Seventy-nine patients undergoing laparoscopic sigmoid resection (LSR) were compared with 79 matched controls with open sigmoid resection (OSR) operated on at two institutions during the same period. Patients were well matched for age, gender, body mass index, ASA grading and symptoms duration, but not for follow-up length (81.9 vs. 86.9 months, p = 0.046). The rate of splenic flexure mobilization (19 vs. 41, p 0.001), specimen length (16.1 vs. 18.3 cm, p = 0.048), presence of inflammation at proximal resection margin (21 vs. 4, p 0.001), and presence of teniae coli at distal resection margin (4 vs. 53, p 0.001). Three LSR patients and 7 OSR patients had one recurrence (p = 0.19). There were no significant differences in rates of flexure mobilization, specimen length, and rates of inflammation present at proximal resection margin in 10 recurring and 145 non-recurring patients. The rate of teniae coli present at distal resection margin was significantly increased in recurring patients (7 vs. 43, p = 0.03). Surgical access to sigmoid resection for UDS is unlikely to have an impact on recurrence rates provided that the oral bowel end is anastomosed to the proximal rectum rather than to the distal sigmoid. 相似文献
5.
Bastiaan R. Klarenbeek Veerle M. H. Coup�� Donald L. van der Peet Miguel A. Cuesta 《Surgical endoscopy》2011,25(3):776-783
Background
Direct healthcare costs of patients with symptomatic diverticular disease randomized for either laparoscopic or open elective sigmoid resection are compared. Cost-effectiveness analysis of the laparoscopic approach compared with open sigmoid resections is presented. 相似文献6.
Background
Laparoscopic sigmoid resection is a feasible and frequent operation for patients who suffer from recurrent diverticulitis. There is still an ongoing debate about the optimal timing for surgery in patients who suffer from recurrent diverticulitis episodes. In elective situations the complication rate for this procedure is moderate, but there are patients at high risk for perioperative complications. The few identified risk factors so far refer to open surgery. Data for the elective laparoscopic approach is rare. The objective of this study was to identify potential predictive risk factors for intra- and postoperative complications in patients who underwent laparoscopic sigmoid resection due to diverticular disease. 相似文献7.
R. Cirocchi E. Farinella S. Trastulli F. Sciannameo R. A. Audisio 《Colorectal disease》2012,14(6):671-683
Aim A meta‐analysis of nonrandomized studies and one randomized trial was conducted to compare laparoscopic surgery with open surgery in the elective treatment of patients with diverticular disease. Method Published randomized and controlled clinical trials that directly compared elective open (OSR) with laparoscopic surgical resection (LSR) in patients with diverticular disease were identified using the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. End‐points included 30‐day mortality and morbidity and were compared by determining the relative risk ratio, odds ratio, and the absolute effects. Results Eleven nonrandomized studies of 1430 patients were identified and included in the meta‐analysis. There was only one randomized study, which included 104 patients. The meta‐analysis suggested that elective LSR was a safe and appropriate option for patients with diverticular disease and was associated with lower overall morbidity (P = 0.01) and minor complication rate (P = 0.008). Conclusion The results of the nonrandomized study generally agreed with those of the randomized study, except for the incidence of minor complications, which was higher in both the LSR and OSR groups of the randomized study. In this study, the high overall morbidity of 42.3% reported in the LSR group is a cause for concern. 相似文献
8.
9.
Ramos-Valadez DI Ragupathi M Nieto J Patel CB Miller S Pickron TB Haas EM 《Surgical endoscopy》2012,26(1):96-102
Background
Single-incision laparoscopic surgery is an emerging modality that has proven to be safe and feasible for colon resection in multiple case reports and series. Nonetheless, comparative analyses with established techniques are limited in the published literature. We evaluated the efficacy of single-incision laparoscopic colectomy (SILC) for the treatment of sigmoid disease through a matched-case comparison with conventional laparoscopic colectomy (CLC). 相似文献10.
Background
Surgical site infection (SSI) in patients who underwent colorectal surgery is a common complication associated with increased morbidity and costs. The aim of this study was to assess risk factors for SSI in laparoscopic sigmoid resection for benign disease. 相似文献11.
Bastiaan R Klarenbeek Alexander AFA Veenhof Elly SM de Lange Willem A Bemelman Roberto Bergamaschi Piet Heres Antonio M Lacy Wim T van den Broek Donald L van der Peet Miguel A Cuesta 《BMC surgery》2007,7(1):16
Backround
Diverticulosis is a common disease in the western society with an incidence of 33–66%. 10–25% of these patients will develop diverticulitis. In order to prevent a high-risk acute operation it is advised to perform elective sigmoid resection after two episodes of diverticulitis in the elderly patient or after one episode in the younger (< 50 years) patient. Open sigmoid resection is still the gold standard, but laparoscopic colon resections seem to have certain advantages over open procedures. On the other hand, a double blind investigation has never been performed. The Sigma-trial is designed to evaluate the presumed advantages of laparoscopic over open sigmoid resections in patients with symptomatic diverticulitis. 相似文献12.
Bjørn Edwin Airazat M Kazaryan Tom Mala Per F Pfeffer Tor Inge Tønnessen Erik Fosse 《BMC surgery》2001,1(1):2-5
Backround
Laparoscopic adrenalectomy is a promising alternative to open surgery although concerns exist in regard to laparoscopic treatment of pheocromocytoma. This report compares the outcome of laparoscopic and conventional (open) resection for pheocromocytoma particular in regard to intraoperative hemodynamic stability and postoperative patient comfort. 相似文献13.
Background Hand-assisted laparoscopic colectomy has been introduced as an alternative to the standard laparoscopic technique, but it has not yet been established whether it offers the same benefits. Therefore, we compared the outcome of patients undergoing hand-assisted laparoscopic sigmoid resection (HALSR) to that of those undergoing laparoscopic sigmoid resection (LSR).Methods The study population comprised a sequential series of consecutive patients undergoing elective laparoscopic sigmoid/left colectomy. Values are reported as mean (range).Results There were 85 LSR patients and 66 HALSR patients, with no differences in patient demographics or diagnoses. There were slight differences in operative time favoring HALSR (LSR 205 min (90–380) vs HALSR 189 min (120–290); p = 0.07), and the extraction incision was larger in the HALSR group (LSR 6.2 cm (3–25) vs HALSR 8.1 cm (7–12); p < 0.01). There was no difference in time for return of bowel function (LSR 2.8 days (1–15) vs HALSR 2.5 days (1–8); p = 0.31) or length of hospital stay (LSR 5.0 days (2–17) vs HALSR 5.2 days (3–22); p = 0.73). Complications were similar in the two groups (LSR 23% vs HALSR 21%), but there were fewer conversions in the hand-assisted group (HALSR 0% vs LSR 13%; p < 0.01).Conclusions Hand-assisted laparoscopic sigmoid resection yields the same outcomes as standard laparoscopic techniques, but with fewer conversions. Hand-assistance is a helpful innovation that may expand the application of laparoscopic colectomy.Presented at the scientific session of the annual meeting of the society of American Gastrointestinal Endoscopic Surgeons (SAGES), Denver, CO, USA, 3 April 2004 相似文献
14.
Yi Han Yong-Gang He Hao-Bo Zhang Ke-Zhi Lv Ya-Jie Zhang Mou-Bin Lin Lu Yin 《Surgical endoscopy》2013,27(2):518-524
Background
This study was designed to evaluate the feasibility and safety of total laparoscopic sigmoid and rectal surgery without abdominal incision in combination with transanal endoscopic microsurgery (TEM).Methods
From May 2010 to October 2011, 34 patients with colon and rectal tumors were treated by total laparoscopic surgery without abdominal incision, and the clinical data of these patients were reviewed.Results
All operations could be successfully accomplished without conversion to open surgery. No diverting ileostomy was created. The average operative time was 151.60 (range, 125–185) minutes. The average blood loss was 200.20 (range, 55–450) ml. All resection margins were negative. Six patients developed postoperative anastomotic leakage. There were no reports of other complications in all patients.Conclusions
This preliminary study indicated that total laparoscopic sigmoid and rectal surgery in combination with TEM was a safe, feasible, and minimally invasive technique. This advanced surgical technique was developed by combining laparoscopy with the concept of natural orifice transluminal endoscopic surgery. 相似文献15.
Khaled El Zarrok Elgazwi Ivo Baca Leszek Grzybowski Armin Jaacks 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2010,14(4):469-475
Background:
Surgical treatment of complicated colonic diverticular disease is still debatable. The aim of this prospective study was to evaluate the outcome of laparoscopic sigmoid colectomy in patients with diverticulitis. Patients offered laparoscopic surgery presented with acute complicated diverticulitis (Hinchey type I, II, III), chronically recurrent diverticulitis, bleeding, or sigmoid stenosis caused by chronic diverticulitis.Method:
All patients who underwent laparoscopic colectomy within a 12-year period were prospectively entered into a database registry. One-stage laparoscopic resection and primary anastomosis constituted the planned procedure. A 4-trocar approach with suprapubic minilaparotomy was performed. Main data recorded were age, sex, postoperative pain, return of bowel function, operation time, duration of hospital stay, and early and late complications.Results:
During the study period, 260 sigmoid colectomies were performed for diverticulitis. The cohort included 104 male and 156 female patients; M to F ratio was 4:6. Postoperative pain was controlled by NSAIDs or weak opioid analgesia. Fifteen patients (5.7%) required conversion from laparoscopic to open colectomy. The most common reasons for conversion were directly related to the inflammatory process, abscess, and peritonitis. Mean operative time was 130±54. Average postoperative hospital stay was 10±3 days. A longer hospital stay was recorded for Hinchey type IIb patients. Complications were recorded in 30 patients (11.5%). The most common complications that required reoperation were hemorrhage in 2 patients (0.76) and anastomotic leak in 5 patients (only 3 of them required reoperation). The mortality among them was 2 patients (0.76%).Conclusions:
Laparoscopic surgery for diverticular disease is safe, feasible, and effective. Therefore, laparoscopic colectomy has replaced open resection as standard surgery for recurrent and complicated diverticulitis at our institution. 相似文献16.
Jung Wook Huh Yang Seok Koh Hyeong Rok Kim Chol Kyoon Cho Young Jin Kim 《Surgical endoscopy》2011,25(1):193-198
Background
The role of laparoscopic colorectal resection for patients undergoing a simultaneous operation for liver metastases had not been established. This study compared the outcomes between laparoscopic and open colorectal resections for patients undergoing simultaneous surgery for liver metastases. 相似文献17.
Masoomi H Buchberg B Nguyen B Tung V Stamos MJ Mills S 《World journal of surgery》2011,35(9):2143-2148
Background
The role of laparoscopy in the management of diverticular disease is evolving. Concerns were raised in the past because laparoscopic resection for diverticulitis is often difficult and occasionally hazardous. This study was undertaken to evaluate the difference in overall outcomes between elective open and laparoscopic surgery with or without anastomosis for diverticulitis. 相似文献18.
Jun Seok Park Gyu-Seog Choi Kyoung Hoon Lim You Seok Jang Soo Han Jun 《Surgical endoscopy》2011,25(1):240-248
Background
In recent years, robot-assisted surgery using the da Vinci System? has been proposed as an alternative to traditional open or laparoscopic procedures. The aim of this study was to compare the short-term outcomes for open, laparoscopic, and robot-assisted rectal resection for cancer. 相似文献19.
Purpose
The safety and effectiveness of laparoscopic surgery is well established for recurrent, uncomplicated diverticular disease, but not for complicated diverticular disease. Using the Hinchey classification, we compared laparoscopic colon resection (LAPH) with conventional open colon resection (OPH) for the treatment of complicated diverticulitis equivalent to Hinchey stage I–II. 相似文献20.
Ichiro Takemasa Mitsugu Sekimoto Masataka Ikeda Tsunekazu Mizushima Hirofumi Yamamoto Yuichiro Doki Masaki Mori 《Surgical endoscopy》2010,24(9):2321-2321