Abstract：
BACKGROUND: We assessed feasibility and safety of laparoscopic sigmoidectomy for complicated fistulizing diverticular disease in a tertiary care colorectal center.
METHODS: A single-center retrospective study of patients undergoing sigmoidectomy for fistulizing diverticular disease between 2011 and 2021 was realized. Primary outcomes were rates of conversion to open surgery and severe postoperative morbidity at 30 days. Secondary outcomes included rates of postoperative bladder leaks on cystogram.
RESULTS: Among the 104 patients, 32.7% had previous laparotomy. Laparoscopy was the initial approach in 103 (99.0%), with 6 (5.8%) conversions to laparotomy. Clavien-Dindo grade ≥ III complication rate at 30 days was 10.6%, including two (1.9%) anastomotic leaks. The median postoperative length of stay was 4.0 days. Seven (6.7%) patients underwent reoperation, six (5.8%) were readmitted, and one (0.9%) died within 30 days. Twelve (11.5%) ileostomies were created initially, and two (1.9%) were created following anastomotic leaks. At last follow-up, 101 (97.1%) patients were stoma-free. Urgent surgeries had a higher rate of severe postoperative complications. Among colovesical fistula patients (n = 73), postoperative cystograms were performed in 56.2%, identifying two out of the three bladder leaks detected on closed suction drains. No differences in postoperative outcomes occurred between groups with and without postoperative cystograms, including Foley catheter removal within seven days (73.2% vs. 90.6%, p = 0.08).
CONCLUSIONS: Laparoscopic surgery for complicated fistulizing diverticulitis showed low rates of severe complications, conversions to open surgery and permanent stomas in high-volume colorectal center.
METHODS: A single-center retrospective study of patients undergoing sigmoidectomy for fistulizing diverticular disease between 2011 and 2021 was realized. Primary outcomes were rates of conversion to open surgery and severe postoperative morbidity at 30 days. Secondary outcomes included rates of postoperative bladder leaks on cystogram.
RESULTS: Among the 104 patients, 32.7% had previous laparotomy. Laparoscopy was the initial approach in 103 (99.0%), with 6 (5.8%) conversions to laparotomy. Clavien-Dindo grade ≥ III complication rate at 30 days was 10.6%, including two (1.9%) anastomotic leaks. The median postoperative length of stay was 4.0 days. Seven (6.7%) patients underwent reoperation, six (5.8%) were readmitted, and one (0.9%) died within 30 days. Twelve (11.5%) ileostomies were created initially, and two (1.9%) were created following anastomotic leaks. At last follow-up, 101 (97.1%) patients were stoma-free. Urgent surgeries had a higher rate of severe postoperative complications. Among colovesical fistula patients (n = 73), postoperative cystograms were performed in 56.2%, identifying two out of the three bladder leaks detected on closed suction drains. No differences in postoperative outcomes occurred between groups with and without postoperative cystograms, including Foley catheter removal within seven days (73.2% vs. 90.6%, p = 0.08).
CONCLUSIONS: Laparoscopic surgery for complicated fistulizing diverticulitis showed low rates of severe complications, conversions to open surgery and permanent stomas in high-volume colorectal center.
摘要：
背景：我们评估了在三级护理中心进行腹腔镜乙状结肠切除术治疗复杂的造瘘憩室病的可行性和安全性。
方法：对2011年至2021年接受乙状结肠切除术治疗憩室病的患者进行了单中心回顾性研究。主要结果是在30天时转换为开放手术和严重的术后发病率。次要结果包括膀胱造影上的术后膀胱渗漏率。
结果：在104例患者中，32.7%曾进行过剖腹手术。腹腔镜检查是103例（99.0%）的初始方法，6例（5.8％）转换为剖腹手术。30天Clavien-Dindo≥III级并发症发生率为10.6%，包括两个（1.9％）吻合口漏。术后中位住院时间为4.0天。7名(6.7%)患者接受了再次手术，6人(5.8%)再次入院,1人(0.9%)在30天内死亡。最初创建了十二个（11.5％）回肠造口术，吻合口漏后产生了两个（1.9％）。在最后的随访中，101例（97.1%）患者无气孔。紧急手术术后严重并发症发生率较高。在结肠膀胱瘘患者中（n=73），56.2%的患者进行了术后膀胱造影检查,确定在封闭的抽吸排水沟上检测到的三个膀胱泄漏中的两个。术后结果在有和没有术后膀胱造影的组之间没有差异，包括7天内拔除Foley导管(73.2%vs.90.6%,p=0.08)。
结论：腹腔镜手术治疗复杂的造瘘性憩室炎的严重并发症发生率低，在高容量结直肠中心转换为开放手术和永久性造口。
方法：对2011年至2021年接受乙状结肠切除术治疗憩室病的患者进行了单中心回顾性研究。主要结果是在30天时转换为开放手术和严重的术后发病率。次要结果包括膀胱造影上的术后膀胱渗漏率。
结果：在104例患者中，32.7%曾进行过剖腹手术。腹腔镜检查是103例（99.0%）的初始方法，6例（5.8％）转换为剖腹手术。30天Clavien-Dindo≥III级并发症发生率为10.6%，包括两个（1.9％）吻合口漏。术后中位住院时间为4.0天。7名(6.7%)患者接受了再次手术，6人(5.8%)再次入院,1人(0.9%)在30天内死亡。最初创建了十二个（11.5％）回肠造口术，吻合口漏后产生了两个（1.9％）。在最后的随访中，101例（97.1%）患者无气孔。紧急手术术后严重并发症发生率较高。在结肠膀胱瘘患者中（n=73），56.2%的患者进行了术后膀胱造影检查,确定在封闭的抽吸排水沟上检测到的三个膀胱泄漏中的两个。术后结果在有和没有术后膀胱造影的组之间没有差异，包括7天内拔除Foley导管(73.2%vs.90.6%,p=0.08)。
结论：腹腔镜手术治疗复杂的造瘘性憩室炎的严重并发症发生率低，在高容量结直肠中心转换为开放手术和永久性造口。
