Laparoscopic Versus Open Emergent Sigmoid Resection for Perforated Diverticulitis

Area of Science:

• Minimally Invasive Surgery
• Gastrointestinal Surgery
• Surgical Outcomes Research

Background:

• Perforated diverticulitis management often involves sigmoidectomy.
• The efficacy of laparoscopic sigmoidectomy versus open surgery remains under investigation.

Purpose of the Study:

• To compare outcomes of emergent laparoscopic sigmoidectomy with traditional open sigmoidectomy for perforated diverticulitis.

Main Methods:

• Utilized the ACS-NSQIP database (2012-2017) for emergent laparoscopic and open sigmoidectomy cases.
• Employed propensity score weighting to compare 30-day outcomes, considering converted cases separately and in an intention-to-treat analysis.

Main Results:

• Laparoscopic approach (intention-to-treat) showed fewer complications, less unplanned intubation, and reduced acute renal failure compared to open surgery.
• Laparoscopic procedures had longer operative times but shorter hospital stays.
• Subgroup analyses favored the laparoscopic approach for both Hartmann's procedure and primary anastomosis.

Conclusions:

• Emergent laparoscopic sigmoidectomy offers favorable outcomes compared to the open approach for perforated diverticulitis.
• High conversion rates necessitate training to increase minimally invasive surgery adoption.
• Further randomized trials are warranted to critically assess these findings.