Laparoscopy decreases anastomotic leak rate in sigmoid colectomy for diverticulitis

Abstract

Background: Early studies comparing laparoscopic and open operations for diverticulitis failed to show any advantages of the laparoscopic approach. Our study compared the 30-day postoperative outcomes of laparoscopic and open sigmoid colectomy for diverticulitis by surgeons who had performed 20 or more laparoscopic colectomies before the study period. Hypothesis: Patients who undergo an elective laparoscopic operation for diverticulitis have reduced postoperative complications compared with patients who have a traditional open operation. Design: Retrospective analysis. Setting: Academic medical center. Patients: A total of 249 patients who underwent elective open (n=127) or laparoscopic (n=122) sigmoid colectomy with primary anastomosis for diverticulitis between July 1, 2001, and February 1, 2008. Main OutcomeMeasures: Combined rates of free and contained anastomotic leaks. A logistic regression model was used to determine predictors of anastomotic leaks while controlling for significant differences between study groups. Results: Patients who underwent laparoscopic or open operations were similar in age, sex, history of diagnosed intraabdominal abscess (9.4% vs 12.3%), and history of preoperative percutaneous abscess drainage (3.9% vs 4.9%). Patients who underwent the open procedure had a higher Charlson comorbidity index (1.6 vs 1.2; P=.04), and those who underwent laparoscopy more frequently underwent splenic flexure mobilization (82.8% vs 26.7%; P