Results

The indications for elective resection were mainly acute diverticulitis or chronic diverticulitis with stenosis, with only occasional patients having fistula to the bladder. The conversion rate ranged from 4% to 26%, the operative time 120-240 min, the time to tolerate regular diet 1-21 days, the length of hospital stay 2-55 days, the morbidity 0%-23.7%, and the mortality 0%-3% (Table 11.3.1).

In the comparative cohort studies, the relative risk (RR) of morbidity was 0.37 [confidence interval (CI) 0.25-0.56] (Figure 11.3.1) in the laparoscopic group and the RR of wound infection was only 0.4 (CI 0.17-0.94) (Figure 11.3.2). The weighted mean difference (WMD) of the operative time was 76.9 (CI 15.5-138.3) minutes longer in the laparoscopic group (Figure 11.3.3) and the hospital stay was 4.1 (CI

Table 11.3.1. Results of case series

Author

Year

n

Conversion [%]

Morbidity [%]

Mortality [%]

Operation time [min]

Diet [days]

Stay [days]

Eijsbouts et al.5

1997

41

15

17

0

195

-

6.5

Franklin et al.4

1997

164

9

15

-

120 (90-240)

-

-

Bouillot et al.6

1998

50

8

14

0

195 (150-280)

-

10 (6-22)

Stevenson et al.7

1998

100

8

21

0

180 (60-310)

-

4 (2-33)

Köckerling et al.8

1999

304

7

16

3

-

-

-

Schlachta et al.9

1999

92

7

18

0

150-165

3

5-6

Siriser et al.10

1999

65

5

14

0

179 ± 44

2.6 ± 1.3

7.6 ± 3

Smadja et al.11

1999

54

9

13

0

298 ± 61

2.3 ± 0.7

6.4 ± 2.7

Berthou et al.12

1999

110

8

7

0

167 ± 65

-

8,2-13,5

Martinez et al.13

1999

38

7

24

0

215 ± 66

3 ± 1.7

4 ± 1.3

Vargas et al.14

2000

69

26

0

0

155 (90-320)

-

-

Trebuchet et al.15

2002

170

4

8

0

141 ± 36

3.4 ± 2.1

8.5 ± 3.7

Le Moine et al.16

2003

168

14

21

0

240 (210-300)

4.8 (2-21)

-

Schwandner et al.17

2004

396

7

17

2

193 (75-400)

6.8 (3-19)

11.8 (4-71)

All

2000

9.9

14.5

0.3

Table 11.3.2. Method of the comparative cohort studies

Author

Period (months)

Rate

Bruce et al.18

Retrospective chart review. Two independent surgical teams which performed either laparoscopic or conventional resection.

Liberman et al.19

Fourteen laparoscopic resections were compared with matched medical records of 14 open cases.

Laparoscopic resections were performed by a single surgeon and prospectively documented. The laparoscopic group was compared with a historical group of the same institution.

Tuech et al.21

Prospective study. Patients may also be included in the study by Thaler et al. Two separate surgical teams were used to perform either laparoscopic or conventional resection.

Faynsod et al.22

Retrospective chart review. The laparoscopic cases were matched with 20 open resections.

Dwivedi et al.23

Retrospective chart review. Two hundred twenty-three charts were primarily reviewed and 69 excluded. Two surgeons accomplished exclusively all laparoscopic resections.

Senagore et al.3

Retrospective chart review. All laparoscopic resections were performed by a single surgeon.

Thaler et al.2

Laparoscopic and open resection were performed by two institutions from 1992 to 2000. Primary endpoint was recurrence. It was not stated how many patients were followed.

Retrospective chart review on all patients operated on because of diverticulitis.

The period of surgery and number of resections are given to calculate the resection rate per month and institution (rate).

Diverticulitis Laparoscopic Surgery
Figure 11.3.1. Morbidity [risk ratio (RR) including the 95% CI] after laparoscopic and conventional surgery for diverticulitis.
Surgery For Divirticulitis
Figure 11.3.2. Wound infections [risk ratio (RR) including the 95% CI] after laparoscopic and conventional surgery for diverticulitis.

Review: Divertikulitis

Comparison: 01 Laparoscopic vs conventional

Outcome: 04 Operative time

Study or sub-category

Laparoscopic Mean (SD)

Conventional Mean (SD)

N

Bruce et al.

25

397.00 (9.10)

17

115.00 (5.10)

282.00 [277.69, 286.31]

Köhler et al.

27

165.00 (21.00)

341

121.00 (21.00)

44.00 [35.77, 52.23]

Faynsod et al.

20

251.00 (68.00)

20

243.00 (49.20)

8.00 [-28.78, 44.78]

Dwivedi et al.

66

212.00 (7.20)

88

143.00 (5.70)

69.00 [66.89, 71.11]

Senagore et al.

61

109.00 (7.00)

71

101.00 (7.00)

8.00 [5.60, 10.40]

Lawrence et al.

56

170.00 (45.00)

215

140.00 (49.00)

-

30.00 [16.52, 43.48]

Total (95% Cl)

255

752

73.88 [-8.25, 156.02]

Test for heterogeneity: Chi2 = 11938.58, df = 5 (P < 0.00001), l2 = 100.0% Test for overall effect: Z = 1.76 (P = 0.08)

Test for heterogeneity: Chi2 = 11938.58, df = 5 (P < 0.00001), l2 = 100.0% Test for overall effect: Z = 1.76 (P = 0.08)

-1000 -500 0 500 1000 Laparoscopic surgery Conventional surgery

Figure 11.3.3. Operative time (WMD including the 95% CI) after laparoscopic and conventional surgery for diverticulitis.

Review: Divertikulitis

Comparison: 01 Laparoscopic vs conventional

Outcome: 08 Hospital stay

Study Laparoscopic Conventional WMD (random)

Review: Divertikulitis

Comparison: 01 Laparoscopic vs conventional

Outcome: 08 Hospital stay

Study Laparoscopic Conventional WMD (random)

Bruce et al.

25

4.20 (1.10)

17

6.80 (1.10)

Köhler et al.

27

7.90 (1.20)

34

14.30 (2.30)

-

Faynsod et al.

20

4.80 (2.30)

20

7.80 (1.50)

-

Dwivedi et al.

66

4.80 (1.20)

88

8.80 (1.50)

Senagore et al.

61

3.10 (0.20)

71

6.80 (0.40)

Total (95% Cl)

199

230

Test for heterogeneity: Ch

= 48.03, df =

4 (P < 0.00001), l2

= 91.7%

Test for overall effect: Z =

10.01 (P < 0.00001)

Laparoscopic surgery Conventional surgery

Figure 11.3.4. Hospital stay (WMD including the 95% CI) after laparoscopic and conventional surgery for diverticulitis.

Laparoscopic surgery Conventional surgery

Figure 11.3.4. Hospital stay (WMD including the 95% CI) after laparoscopic and conventional surgery for diverticulitis.

2.4-5.8) days shorter (Figure 11.3.4). Mortality was very low and not different.

Recurrence after resection was investigated in one study (n = 236).2 The authors described a low recurrence rate of 5% (n = 12) but they did not state how many patients were actually followed. A difference between laparoscopic and conventional surgical groups was not found.

One study (n = 132) analyzed the direct costs for laboratory services, pharmacy, radiology, anesthesia, operating room, and hospitalization.3 The direct costs per case were $3.458 ± 437 for laparoscopic resections and $4.321 ± 501 for conventional procedures. The length of stay was 3.1 ± 0.2 days in the laparoscopic group and 6.8 ± 0.4 days in the conventional group.

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