Methods

Search of Literature

The MEDLINE database via PUBMED was searched for English literature published since 1991. The MeSh terms "diverticulitis" and "laparoscopic*" were used for the search. All 240 abstracts of the discovered literature were evaluated. Individual case reports and small case series (less than 20) were excluded as well as mixed studies which included patients with cancer, adenomas, or other inflammatory diseases. Included were 24 observational studies (15 simple case series and 9 comparative cohort studies).

Outcomes

The studies were carefully analyzed and the following items extracted if given: Morbidity, mortality, the proportion of conversion to a conventional approach, the duration of surgery, time to first flatus, time to resumption of a regular diet, and the length of postoperative hospital stay. The same endpoints were looked at in the comparative cohort studies, summarized in an "intent-to-treat" analysis, and compared between laparoscopic and conventional surgery. If long-term results were available, the length of follow-up and recurrence rate were documented.

Data Analysis

The overall quality of the studies is level 3-5. There are no randomized controlled trials (RCTs) that compared both approaches in patients with diverticulitis. This is somewhat surprising because in some countries diverticular disease is the most common indication for laparoscopic sigmoid resection. In theory, it should be easy to set up some RCTs from experienced centers. One small study compared whether the anastomosis should be accomplished after closure of the laparotomy and establishing a pneumoperitoneum or through a small suprapubic

Most of the studies we found were very small retrospective or prospective case series which were excluded from this analysis. Fifteen larger studies with more than 20 patients were evaluated (Table 11.3.1). Nine comparative cohort studies were also included (Table 11.3.2).

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