Our Summary

This research paper reviews existing studies to assess whether a specific type of minimally invasive surgery can be used as an emergency treatment for a severe form of diverticulitis, a digestive disease. The surgery in question is called laparoscopic sigmoidectomy, and it involves the removal of a part of the large intestine.

Traditionally, this surgery has been performed in non-emergency situations, while a more invasive surgery was used in emergencies. However, the more invasive surgery has high rates of complications, which led the researchers to explore the potential for using the less invasive surgery in emergency situations.

From the studies they reviewed, they found that the less invasive surgery could indeed be used in emergency situations, as long as it was performed by a highly skilled surgeon. They noted that the surgery times varied between 115 to 200 minutes, the hospital stay ranged from 6 to 16 days, and the rate of having to switch to a more invasive surgery during the operation varied from 0 to 19%.

In cases where the surgery was successful, 76% of patients were able to undergo a procedure to reverse a temporary stoma, which is a surgical opening in the abdomen to allow waste to leave the body. Only three patients died during the postoperative period, and no leakage was reported in patients who had surgery without a stoma.

In summary, the paper suggests that this less invasive surgery can be a viable emergency treatment for severe diverticulitis, but it emphasizes the importance of it being performed by an experienced surgeon.

FAQs

  1. What is the aim of the systematic review on emergency laparoscopic sigmoidectomy for perforated diverticulitis?
  2. How many patients, and what types of studies, were included in this review on laparoscopic sigmoidectomy for perforated diverticulitis?
  3. What were the results and conclusions regarding the feasibility of acute laparoscopic sigmoidectomy for the treatment of perforated diverticulitis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sigmoidectomy is to make sure to follow all post-operative care instructions closely, including taking any prescribed medications, keeping the incision area clean and dry, and attending follow-up appointments with your healthcare provider. It is also important to gradually resume normal activities and to avoid heavy lifting or strenuous exercise until cleared by your doctor. If you experience any unusual symptoms or complications after surgery, be sure to contact your healthcare provider immediately.

Suitable For

Patients with perforated diverticulitis (Hinchey III-IV) who are hemodynamically stable and have no signs of generalized peritonitis are typically recommended for laparoscopic sigmoidectomy. It is important that these patients are carefully selected and managed by experienced surgeons to minimize the risk of complications.

Timeline

Before sigmoidectomy:

  • Patient presents with symptoms of perforated diverticulitis (such as severe abdominal pain, fever, and nausea)
  • Diagnosis confirmed through imaging studies (such as CT scan)
  • Patient undergoes evaluation by a surgeon to determine the need for emergency surgery
  • Consent obtained from the patient for laparoscopic sigmoidectomy
  • Surgery scheduled and patient prepared for the procedure

After sigmoidectomy:

  • Laparoscopic sigmoidectomy performed, with either Hartmann’s procedure or primary anastomosis
  • Operating time ranges between 115 and 200 minutes
  • Conversion rate to open surgery ranges from 0 to 19%
  • Length of hospital stay ranges between 6 and 16 days
  • Surgical re-intervention necessary in 2 patients
  • Anastomotic leakage reported in 0 out of 20 patients without defunctioning ileostomy
  • Postoperative mortality reported in 3 patients
  • Stoma reversal performed in 76% of patients who underwent Hartmann’s procedure
  • Follow-up care provided to monitor recovery and address any complications

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a sigmoidectomy for perforated diverticulitis?
  2. How experienced are you in performing emergency laparoscopic sigmoidectomy for perforated diverticulitis?
  3. What is the expected recovery time and postoperative care following a sigmoidectomy?
  4. Will I need a temporary colostomy or ileostomy after the surgery?
  5. What is the likelihood of needing a conversion to open surgery during the procedure?
  6. How soon after the surgery can I resume normal activities and return to work?
  7. What long-term effects or complications should I be aware of after undergoing a sigmoidectomy?
  8. Are there any dietary or lifestyle changes I should make to help with my recovery and prevent future episodes of diverticulitis?
  9. How often will I need follow-up appointments to monitor my progress after the surgery?
  10. Are there any alternative treatments or procedures that may be considered for my condition?

Reference

Authors: Vennix S, Boersema GS, Buskens CJ, Menon AG, Tanis PJ, Lange JF, Bemelman WA. Journal: Dig Surg. 2016;33(1):1-7. doi: 10.1159/000441150. Epub 2015 Nov 10. PMID: 26551040