Our Summary

This research looks at how often surgeries for diverticular disease (a common digestive disease) need to be changed from a minimally invasive surgery to a more traditional open surgery, and what factors might influence this. The researchers used US healthcare data to look at patients who had a specific type of surgery for this condition, called a sigmoidectomy, between 2013 and 2015. They compared two types of minimally invasive surgeries - laparoscopic and robotic-assisted - and looked at which patients were more likely to have their surgery switched to an open surgery.

The study found that laparoscopic surgeries were more likely to be changed to open surgeries than robotic-assisted ones (13.6% vs 8.3%). Some factors that increased the risk of this happening included: being Black, having Medicaid insurance, having other health conditions, being obese, needing an additional colon resection, having an abdominal abscess or fistula, or needing removal of scar tissue. On the other hand, patients were less likely to have their surgery switched if it was a robotic-assisted surgery, if the surgeon used their hand during the surgery, if the surgeon did a lot of these surgeries, or if the surgeon specialized in colorectal surgery.

Having to switch the surgery type resulted in longer operating times, longer hospital stays, more post-surgery complications, and higher rates of needing to be readmitted to the hospital or needing a blood transfusion. It also increased the overall costs of the operation.

In conclusion, having to switch from a minimally invasive to an open surgery for diverticular disease can lead to more health problems and higher costs. Understanding which factors can increase this risk might help to improve patient outcomes.

FAQs

  1. What is the focus of this research regarding surgeries for diverticular disease?
  2. What factors were found to increase the risk of a minimally invasive surgery being switched to an open surgery?
  3. What were the consequences of having to switch from a minimally invasive to an open surgery according to the study?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sigmoidectomy is to discuss with their surgeon the possibility of needing to switch from a minimally invasive to an open surgery. Patients should be aware of the factors that could increase this risk, such as certain health conditions, obesity, or the need for additional procedures. Choosing a surgeon who specializes in colorectal surgery and has experience with sigmoidectomies may reduce the likelihood of needing to switch to an open surgery. It’s important for patients to have open communication with their healthcare team to ensure the best possible outcome for their surgery.

Suitable For

Patients who are typically recommended sigmoidectomy are those with diverticular disease that has not responded to other treatments, such as dietary changes or medications. In particular, patients who have complications such as abscesses, fistulas, or bowel obstructions may require surgery. Additionally, patients who have recurrent episodes of diverticulitis or who experience severe symptoms such as persistent pain, bleeding, or perforation of the colon may also be candidates for sigmoidectomy. It is important for patients to discuss their individual case with their healthcare provider to determine if sigmoidectomy is the best treatment option for them.

Timeline

Before sigmoidectomy:

  1. Patient experiences symptoms of diverticular disease such as abdominal pain, bloating, changes in bowel habits, and rectal bleeding.
  2. Patient undergoes diagnostic tests such as colonoscopy or CT scan to confirm the diagnosis of diverticular disease.
  3. Patient receives conservative treatments such as dietary changes, medications, and lifestyle modifications to manage symptoms.
  4. If conservative treatments are ineffective, patient may be recommended for surgery, such as a sigmoidectomy.

After sigmoidectomy:

  1. Patient undergoes pre-operative preparation which includes fasting, bowel preparation, and consultation with the surgical team.
  2. Patient undergoes sigmoidectomy surgery, either laparoscopic or robotic-assisted, to remove the affected part of the colon.
  3. If the surgery needs to be switched to an open procedure due to complications, patient experiences longer operating times and hospital stays.
  4. Patient experiences post-surgery complications such as infection, bleeding, or bowel obstruction.
  5. Patient may need to be readmitted to the hospital or require a blood transfusion due to the switch in surgery type.
  6. Overall costs of the operation increase due to the need to switch from minimally invasive to open surgery.
  7. Patient undergoes post-operative care and follow-up appointments to monitor recovery and manage any complications.

What to Ask Your Doctor

  1. What are the potential risks and benefits of a laparoscopic sigmoidectomy versus a robotic-assisted sigmoidectomy for my diverticular disease?
  2. What factors could increase the likelihood of needing to switch from a minimally invasive surgery to an open surgery during the sigmoidectomy procedure?
  3. How experienced are you in performing sigmoidectomies, specifically minimally invasive surgeries?
  4. What measures can be taken to reduce the risk of needing to switch to an open surgery during the sigmoidectomy?
  5. What are the potential consequences of having to switch from a minimally invasive to an open surgery during the sigmoidectomy procedure?
  6. How will the potential need to switch surgeries impact my recovery time and overall outcome?
  7. Are there alternative treatment options for my diverticular disease that may reduce the risk of needing to switch surgeries during the sigmoidectomy?
  8. What are the potential long-term implications of needing to switch surgeries during the sigmoidectomy procedure?
  9. How will the cost of the surgery be affected if there is a need to switch from a minimally invasive to an open surgery?
  10. Are there any specific steps I can take before the surgery to reduce the likelihood of needing to switch surgeries during the sigmoidectomy?

Reference

Authors: Bastawrous AL, Landmann RG, Liu Y, Liu E, Cleary RK. Journal: Surg Endosc. 2020 Feb;34(2):598-609. doi: 10.1007/s00464-019-06804-z. Epub 2019 May 6. PMID: 31062152