Abstract
Background
Guideline-concordant delay in elective laparoscopic colectomy for diverticulitis may
result in repeated bouts of inflammation. We aimed to determine whether conversion
rates from elective laparoscopic colectomy are higher after multiple episodes of diverticulitis.
Methods
Prospective cohort study evaluating laparoscopic colectomy conversion rates for diverticulitis
from 42 hospitals was conducted.
Results
Between 2010 and 2013, 1,790 laparoscopic colectomies for diverticulitis (mean age
57.8 ± 13; 47% male) resulted in 295 (16.5%) conversions. Conversion occurred more
frequently in nonelective operations (P < .001) and with fistula indications (P = .012). Conversion rates decreased with surgeon case volume (P = .028). Elective colectomy exclusively for episode-based indications (n = 784) had
a conversion rate of 12.9%. Increasing episodes of diverticulitis were not associated
with higher conversion rates, even among surgeons with similar experience levels.
Conclusions
Conversion from laparoscopic colectomy for diverticulitis did not increase after multiple
episodes of diverticulitis. Delaying elective resection appears to not prevent patients
from the benefits of laparoscopy.
Keywords
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References
- Practice parameters for the treatment of sigmoid diverticulitis.Dis Colon Rectum. 2014; 57: 284-294
- Direct costs of diverticulitis in a US managed care population.Am J Pharm. 2012; 4: e118-e129
- Risk of emergency colectomy and colostomy in patients with diverticular disease.Arch Surg. 2005; 140: 681-685
- Sigmoid diverticulitis: a systematic review.JAMA. 2014; 311: 287-297
- A comparison of laparoscopically assisted and open colectomy for colon cancer.N Engl J Med. 2004; 350: 2050-2059
- Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial.Lancet. 2002; 359: 2224-2229
- Practice parameters for the treatment of sigmoid diverticulitis—supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons.Dis Colon Rectum. 2000; 43: 290-297
- Practice parameters for sigmoid diverticulitis.Dis Colon Rectum. 2006; 49: 939-944
- Can laparoscopically assisted sigmoid resection provide uncomplicated management even in cases of complicated diverticulitis?.Surg Endosc. 2006; 20: 1055-1059
- Laparoscopic resection for diverticular disease: follow-up of 500 consecutive patients.Ann Surg. 2008; 248: 1092-1097
- Addressing the appropriateness of elective colon resection for diverticulitis: a report from the SCOAP CERTAIN collaborative.Ann Surg. 2014; 260 (discussion 538–9): 533-538
- A model for incorporating patient and stakeholder voices in a learning health care network: Washington state's comparative effectiveness research translation network.J Clin Epidemiol. 2013; 66: S122-S129
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol. 1992; 45: 613-619
- Adoption of laparoscopy for elective colorectal resection: a report from the surgical care and outcomes assessment program.J Am Coll Surg. 2012; 214: 909-918.e1
- Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results.Dis Colon Rectum. 2003; 46 (discussion 1378–9): 1371-1378
- Factors and consequences of conversion in laparoscopic sigmoidectomy for diverticular disease.Br J Surg. 2003; 90: 232-236
- Laparoscopic colorectal resections: a simple predictor model and a stratification risk for conversion to open surgery.Dis Colon Rectum. 2014; 57: 869-874
- A prospective, randomized, single-blind comparison of laparoscopic versus open sigmoid colectomy for diverticulitis.Ann Surg. 2010; 252: 3-8
- Laparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control sigma trial.Surg Endosc. 2011; 25: 1121-1126
- Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicenter analysis of 4852 cases.Dis Colon Rectum. 2012; 55: 1300-1310
- Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections.Ann Surg. 2005; 242: 83-91
- The impact of uncomplicated and complicated diverticulitis on laparoscopic surgery conversion rates and patient outcomes.Surg Endosc. 2007; 21: 1690-1694
Article info
Publication history
Published online: February 24, 2015
Received in revised form:
December 23,
2014
Received:
October 16,
2014
Footnotes
Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number T32DK070555. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Surgical Care and Outcomes Assessment Program is a Coordinated Quality Improvement Program of the Foundation for Health Care Quality. The Comparative Effectiveness Research Translation Network is a program of the University of Washington, the academic research and development partner of Surgical Care and Outcomes Assessment Program.
Dr. Bastawrous reported Honoraria from Intuitive Surgical on his disclosure. The other authors declare no conflicts of interest.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
