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A Spinelli1,2, F Di Candido3, M Carvello3

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Summary

Single suprapubic port laparoscopic sigmoidectomy is a feasible and effective approach for treating large diverticular phlegmon and sigmoid-vesical fistula, minimizing wound size and hernia risk.

Keywords:
DiverticulitisPelvic massSingle-port laparoscopySuprapubic incision

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Area of Science:

  • Minimally Invasive Surgery
  • Gastrointestinal Surgery
  • Surgical Oncology

Background:

  • Laparoscopic sigmoidectomy is standard for diverticulitis.
  • Umbilical single-port techniques can be limited by large inflammatory masses.
  • Suprapubic access may reduce incisional hernia risk.

Purpose of the Study:

  • To assess the feasibility of laparoscopic sigmoidectomy via a single suprapubic transverse port.
  • To evaluate this approach for large diverticular phlegmon and associated fistulae.

Main Methods:

  • Twenty patients with inflammatory masses ≥5 cm underwent single suprapubic port (SPSP) sigmoidectomy.
  • Access port was extended as needed for mass extraction.
  • Standard laparoscopic techniques were employed.

Main Results:

  • All 20 procedures were completed with SPSP access, without intraoperative complications.
  • Eight patients had sigmoid-vesical fistulae, with three requiring bladder repair.
  • Median operative time was 178 minutes, median hospital stay was 5.5 days.
  • Four postoperative complications occurred; no incisional hernias were reported at 25-month follow-up.

Conclusions:

  • Single suprapubic port sigmoidectomy is feasible and effective for diverticulitis.
  • This technique minimizes wound complications and hernia risk, especially for complex cases.
  • SPSP sigmoidectomy is a valuable option for large phlegmon and sigmoid-vesical fistulae.