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McKechnie T, Jessani G, Bakir N, Lee Y, Sne N, Doumouras A, Hong D, Eskicioglu C. Evaluating frailty using the modified frailty index for colonic diverticular disease surgery: analysis of the national inpatient sample 2015-2019. Surg Endosc 2024; 38:4031-4041. [PMID: 38874611 DOI: 10.1007/s00464-024-10965-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/26/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Frailty has been associated with increased postoperative mortality and morbidity; however, the use of the modified frailty index (mFI-11) to assess patients undergoing surgery for diverticular disease has not been widely assessed. This paper aims to examine frailty, evaluated by mFI-11, to assess postoperative morbidity and mortality among patients undergoing operative intervention for colonic diverticular disease. METHODS We used data from the Healthcare Cost and Utilization Project National Inpatient Sample (October 1, 2015-December 31, 2019). ICD-10-CM codes were utilized to identify a cohort of adult patients with a primary admission diagnosis of diverticulitis. mFI-11 items were adapted to correspond with ICD-10-CM codes. Patients were stratified into robust (mFI < 0.27) and frail (mFI ≥ 0.27) groups. Primary outcomes were in-hospital postoperative morbidity and mortality. Secondary outcomes included system-specific postoperative complications, length of stay (LOS), total admission cost, and discharge disposition. Multivariable regression models were fit. RESULTS Of the 26,826 patients, there were 24,194 patients with mFI-11 < 0.27 (i.e., robust) and 2,632 patients with mFI-11 ≥ 0.27 (i.e., frail). Adjusted analysis showed significant increases in postoperative mortality (aOR 2.16, 95% CI 1.38-3.38, p = 0.001) and overall postoperative morbidity (aOR 1.84, 95% CI 1.65-2.06, p < 0.001). LOS was higher in the frail group (MD 1.78 days, 95% CI 1.46-2.11, p < 0.001) as well as total cost (MD $25,495.19, 95% CI $19,851.63-$31,138.75, p < 0.001). CONCLUSION In the elective setting, a high mFI-11 (i.e., presence of the variables comprising the index) could alert clinicians to the possibility of implementing preoperative optimization strategies. In the emergent setting, a high mFI-11 may help guide prognostication for these vulnerable patients.
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Ghazal Jessani
- Michael G. DeGroote School of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Noor Bakir
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Niv Sne
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Aristithes Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Michael G. DeGroote School of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
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Stovall SL, Kaplan JA, Law JK, Flum DR, Simianu VV. Diverticulitis is a population health problem: Lessons and gaps in strategies to implement and improve contemporary care. World J Gastrointest Surg 2023; 15:1007-1019. [PMID: 37405108 PMCID: PMC10315108 DOI: 10.4240/wjgs.v15.i6.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 06/15/2023] Open
Abstract
The disease burden of diverticulitis is high across inpatient and outpatient settings, and the prevalence of diverticulitis has increased. Historically, patients with acute diverticulitis were admitted routinely for intravenous antibiotics and many had urgent surgery with colostomy or elective surgery after only a few episodes. Several recent studies have challenged the standards of how acute and recurrent diverticulitis are managed, and many clinical practice guidelines (CPGs) have pivoted to recommend outpatient management and individualized decisions about surgery. Yet the rates of diverticulitis hospitalizations and operations are increasing in the United States, suggesting there is a disconnect from or delay in adoption of CPGs across the spectrum of diverticular disease. In this review, we propose approaching diverticulitis care from a population level to understand the gaps between contemporary studies and real-world practice and suggest strategies to implement and improve future care.
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Affiliation(s)
- Stephanie Lee Stovall
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA 98101, United States
| | - Jennifer A Kaplan
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA 98101, United States
| | - Joanna K Law
- Department of Gastroenterology, Virginia Mason Franciscan Health, Seattle, WA 98101, United States
| | - David R Flum
- Department of Surgery, University of Washington Medical, Seattle, WA 98195, United States
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA 98101, United States
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Mateescu T, Miutescu B, Nicola A, Oancea C, Barata PI, Tarta C, Fulger L, Paleru C. Health-Related Quality of Life and Stress-Related Disorders in Patients with Complicated Diverticular Disease under Conservative Management. Healthcare (Basel) 2023; 11:healthcare11101383. [PMID: 37239668 DOI: 10.3390/healthcare11101383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Diverticular disease is a common gastrointestinal disorder with increasing prevalence in advanced age. This study aimed to investigate the impact of age and complexity of diverticulitis on health-related quality of life (HRQoL) and stress-related disorders. A cross-sectional study was conducted on 180 patients, including adults (18-64 years) with complicated diverticular disease, the elderly (≥65 years) with complicated diverticular disease, and a control group with uncomplicated symptomatic diverticular disease. HRQoL and stress-related disorders were assessed using the SF-36, GIQLI, HADS, and PHQ-9 questionnaires at baseline and six months after the initial episode of diverticulitis. At diagnosis, the adult group had significantly lower mean physical and mental scores compared with the elderly and control groups (p < 0.001). At the 6-month follow-up, the mean physical score increased for all groups, but the difference between adults and the elderly remained significant (p = 0.028). The adult group had a significantly lower mean GIQLI score at diagnosis compared with the elderly and control groups (p < 0.001), although after 6 months it increased and the difference became insignificant. Anxiety scores at diagnosis were significantly higher in the adult group compared with the control group (p = 0.009). The complexity of diverticulitis and age significantly impacted HRQoL at diagnosis, with adults having lower physical and mental scores compared with elderly patients and controls. Although improvements were observed after 6 months, the difference between adults and the elderly remained significant for physical HRQoL scores. This highlights the need for tailored management strategies and psychosocial support to optimize patient outcomes across age groups and diverticulitis complexity.
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Affiliation(s)
- Tudor Mateescu
- Department of General Surgery, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Bogdan Miutescu
- Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Alin Nicola
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Department of Thoracic Surgery, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Paula Irina Barata
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristi Tarta
- Department of General Surgery, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Lazar Fulger
- Department of General Surgery, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristian Paleru
- Department of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, 050474 Bucuresti, Romania
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Harrison NJ, Ford MM, Wolf Horrell EM, Feng M, Ye F, Zhang KC, Hawkins AT. Long-term bowel dysfunction and decision regret in diverticulitis: A mixed methods study. Surgery 2022; 172:1194-1201. [PMID: 35927081 DOI: 10.1016/j.surg.2022.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/27/2022] [Accepted: 04/29/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study had aimed to describe long-term decision regret, bowel dysfunction, and the overall quality of life in patients with diverticulitis, and to determine if elective colectomy was associated with these patient-reported outcome measures. METHODS This mixed-methods, survey-based study was administered to a national cohort of patients in the United States with diverticulitis. We measured decision regret (Brehaut Decision Regret), bowel dysfunction (Low Anterior Resection Syndrome score), and the overall quality of life (EuroQol 5 Dimension) in this population. We asked open-ended questions to elucidate factors that influenced patients' choices between elective colectomy and observation. RESULTS Among the 614 respondents, 294 (48%) chose between colectomy and observational management, 94 (15%) had surgery, and 157 (26%) had major Low Anterior Resection Syndrome. Of the 294 that chose between colectomy and observational management, 51 (17%) experienced decision regret. Colectomy was associated with an average decrease in the Brehaut Decision Regret score by 6 points but was not associated with a categorical measure of decision regret (Brehaut Score ≥50). Bowel dysfunction and overall quality of life were not significantly associated with colectomy. Disease-related factors, psychosocial factors, and interactions with physicians were commonly cited as reasons for pursuing colectomy or observational management. CONCLUSION Patients with self-reported diverticulitis describe high levels of decision regret and bowel dysfunction regardless of chosen management strategy. Physicians should be aware that psychosocial factors can strongly influence a patient's choice between colectomy and observational management. We advocated for future prospective studies using patient reported outcome metrics to improve outcomes in diverticulitis.
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Affiliation(s)
- Noah J Harrison
- School of Medicine, Vanderbilt University, Nashville, TN. https://twitter.com/alexhawkinsmd
| | - Molly M Ford
- Vanderbilt University Medical Center, Division of General Surgery, Section of Colon & Rectal Surgery, Nashville, TN
| | - Erin M Wolf Horrell
- Vanderbilt University Medical Center, Division of General Surgery, Section of Colon & Rectal Surgery, Nashville, TN
| | - Michael Feng
- Vanderbilt University Medical Center, Division of General Surgery, Section of Colon & Rectal Surgery, Nashville, TN
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Kevin C Zhang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Alexander T Hawkins
- Vanderbilt University Medical Center, Division of General Surgery, Section of Colon & Rectal Surgery, Nashville, TN.
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Gray PJ, Goldwag JL, Eid MA, Trooboff SW, Wilson MZ, Ivatury SJ. What Are the Long-Term Changes to Bowel Function Patient-reported Outcomes After Elective Sigmoidectomy for Diverticular Disease?: Observational Study of Patients Undergoing Elective Sigmoidectomy for Diverticular Disease. ANNALS OF SURGERY OPEN 2021; 2:e110. [PMID: 37637876 PMCID: PMC10455065 DOI: 10.1097/as9.0000000000000110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate long-term changes to bowel function after elective sigmoidectomy for diverticular disease. Background For patients with diverticular disease, choosing surgery is often based on the presumption of improvement in preoperative symptoms. Our group previously reported bowel function does not change in the early perioperative period; however, studies of long-term outcomes are limited. Methods This is an observational study of patients that underwent elective sigmoidectomy for diverticular disease and completed the Colorectal Functional Outcome (COREFO) questionnaire before surgery. Patients were stratified into two groups based on presence or absence of a preoperative symptomatic score (i.e., total COREFO ≥ 15). Long-term bowel function (>1 year from surgery) was assessed using the COREFO questionnaire via telephone or subsequent clinic visit. Paired t-tests compared mean preoperative scores to mean long-term scores. Results Fifty-one patients met inclusion criteria (21 symptomatic, 30 asymptomatic). All symptomatic patients had uncomplicated disease, whereas 90% of asymptomatic patients had complicated disease. Median time from operation to questionnaire completion was 23 months (IQR = 13-34). Asymptomatic patients demonstrated impaired bowel function, predominantly driven by changes in the social impact domain. Symptomatic patients demonstrated improved bowel function, driven by changes in the incontinence, social impact, stool-related aspects, and need for medication domains. Conclusions In the long-term after elective sigmoidectomy for diverticular disease, patients with symptomatic bowel function preoperatively improve substantially, while those with asymptomatic preoperative scores demonstrate statistically significant impairment. Patients determined to be symptomatic with patient-reported outcomes likely benefit long-term from sigmoid resection.Mini-Abstract: In this manuscript, long-term changes to patient-reported bowel function were assessed using a validated questionnaire after sigmoidectomy for diverticular disease. We found that in patients with symptomatic preoperative bowel function, long-term bowel function improved after elective resection. Alternatively, patients with asymptomatic preoperative bowel function demonstrated long-term impairment in bowel function.
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Affiliation(s)
| | | | - Mark A. Eid
- From the Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Matthew Z. Wilson
- From the Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geisel School of Medicine, Hanover, NH
| | - Srinivas J. Ivatury
- Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, TX
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Posabella A, Steinemann DC, Droeser RA, Varathan N, Ayçiçek SG, Nocera F, von Flüe M, Rotigliano N, Füglistaler I. Predictive model estimating the decrease of postoperative gastrointestinal quality of life index (GIQLI) in patients after elective laparoscopic sigmoid resection for diverticular disease. Langenbecks Arch Surg 2021; 406:1571-1580. [PMID: 34031729 PMCID: PMC8370950 DOI: 10.1007/s00423-021-02186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/02/2021] [Indexed: 11/21/2022]
Abstract
Background Growing consideration in quality of life (QoL) has changed the therapeutic strategy in patients suffering from diverticular disease. Patients’ well-being plays a crucial role in the decision-making process. However, there is a paucity of studies investigating patients’ or surgery-related factors influencing the postoperative gastrointestinal function. The aim of this study was to investigate in a predictive model patients or surgical variables that allow better estimation of the postoperative gastrointestinal QoL. Methods This observational study retrospectively analyzed patients undergoing elective laparoscopic sigmoidectomy for diverticulitis between 2004 and 2017. The one-time postoperative QoL was assessed with the gastrointestinal quality of life index (GIQLI) in 2019. A linear regression model with stepwise selection has been applied to all patients and surgery-related variables. Results Two hundred seventy-two patients with a mean age of 62.30 ± 9.74 years showed a mean GIQLI of 116.39±18.25 at a mean follow-up time of 90.4±33.65 months. Women (n=168) reported a lower GIQLI compared to male (n=104; 112.85±18.79 vs 122.11±15.81, p<0.001). Patients with pre-operative cardiovascular disease (n=17) had a worse GIQLI (106.65 ±22.58 vs 117.08±17.66, p=0.010). Finally, patients operated less than 5 years ago (n=63) showed a worse GIQLI compared to patients operated more than 5 years ago (n=209; 111.98±19.65 vs 117.71±17.63, p=0.014). Conclusions Female gender and the presence of pre-operative cardiovascular disease are predictive for a decreased postoperative gastrointestinal QoL. Furthermore, patients’ estimation of gastrointestinal functioning seems to improve up to 5 years after surgery. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02186-w.
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Affiliation(s)
- Alberto Posabella
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Disease, St Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland.,Department of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland
| | - Daniel Christian Steinemann
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Disease, St Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland. .,Department of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland.
| | - Raoul André Droeser
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Disease, St Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Nadshathra Varathan
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Disease, St Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Selin Göksu Ayçiçek
- Department of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland
| | - Fabio Nocera
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Disease, St Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Markus von Flüe
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Disease, St Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Niccolò Rotigliano
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Disease, St Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Ida Füglistaler
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Disease, St Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland
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7
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Posabella A, Varathan N, Steinemann DC, Göksu Ayçiçek S, Tampakis A, von Flüe M, Droeser RA, Füglistaler I, Rotigliano N. Long-term urogenital assessment after elective laparoscopic sigmoid resection for diverticulitis: a comparison between central and peripheral vascular resection. Colorectal Dis 2021; 23:911-922. [PMID: 33247526 DOI: 10.1111/codi.15458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 12/23/2022]
Abstract
AIM Increasing attention has been given to postoperative gastrointestinal functional outcome and quality of life after sigmoid resection for diverticulitis. Conversely, very little has been described about postoperative urogenital functional outcome and even less about its potential relationship to the type of vascular approach. The aim of this study was to evaluate whether central ligation of the inferior mesenteric artery (IMA) compared with peripheral dissection could impair urinary and sexual function in the long term. METHOD Patients undergoing elective laparoscopic sigmoid resection for diverticulitis from 2004 to 2017 were retrospectively analysed. They were asked to complete the American Urological Association Symptom Index (AUASI) questionnaire. Men received the five-item version of the International Index of Erectile Function (IIEF-5) questionnaire. Patients were then divided according to the type of vascular resection. RESULTS A response rate of the 36.4% to the AUASI and 43.8% to the IIEF-5 questionnaires was achieved. Three hundred and twenty four patients with a mean age of 62 ± 9.85 years were analysed for their urinary function (IMA preserved n = 217; IMA resected n = 107) in a median follow-up of 87 months. Furthermore, 115 men with a mean age of 60 ± 8.97 years were investigated for their sexual function (IMA preserved n = 80; IMA resected n = 35) in a median follow-up of 89 months. No difference (AUASI: 8 ± 6.32 IMA preserved vs. 7 ± 6.26 IMA resected, P = 0.204; IIEF-5: 15 ± 7.67 IMA preserved vs. 15 ± 8.61 IMA resected, P = 0.674) was found regarding the type of vascular approach during sigmoid resection. CONCLUSIONS No association was found between the type of vascular approach and the long-term urogenital functional outcome in patients undergoing sigmoid resection for diverticulitis.
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Affiliation(s)
- Alberto Posabella
- University Center of Gastrointestinal and Liver Diseases - Clarunis, Basel, Switzerland
| | - Nadshathra Varathan
- University Center of Gastrointestinal and Liver Diseases - Clarunis, Basel, Switzerland
| | | | - Selin Göksu Ayçiçek
- University Center of Gastrointestinal and Liver Diseases - Clarunis, Basel, Switzerland
| | - Athanasios Tampakis
- University Center of Gastrointestinal and Liver Diseases - Clarunis, Basel, Switzerland
| | - Markus von Flüe
- University Center of Gastrointestinal and Liver Diseases - Clarunis, Basel, Switzerland
| | - Raoul André Droeser
- University Center of Gastrointestinal and Liver Diseases - Clarunis, Basel, Switzerland
| | - Ida Füglistaler
- University Center of Gastrointestinal and Liver Diseases - Clarunis, Basel, Switzerland
| | - Niccolò Rotigliano
- University Center of Gastrointestinal and Liver Diseases - Clarunis, Basel, Switzerland
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Beltzer CR, Knörzer L, Dippel H, Schmidt R. [Functional Results after Laparoscopic versus Robot-assisted Sigmoid Resection in Diverticulitis]. Zentralbl Chir 2020; 146:68-75. [PMID: 32702764 DOI: 10.1055/a-1209-3724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sigmoid resection in diverticulitis is one of the most frequently performed colonic operations. A minimally invasive approach by laparoscopy is the surgical gold standard. For a few years now, sigmoid resections have also been performed robotically (da Vinci® System). It is unclear whether there are relevant differences between the two procedures in terms of functional outcome. METHODS A postoperative follow-up was performed on all patients who underwent laparoscopic or robotic sigmoid resection for diverticulitis between November 2013 and November 2018, with a minimum interval of 6 months between surgery. Continence disorders, the development of symptoms compared to preoperative, changes in bowel movement (constipation, diarrhoea), impairment in daily life and pain were recorded. Differences between the groups were checked for statistical significance using the chi-square test. RESULTS During the study period, a total of 106 minimally invasive sigmoid resections for diverticulitis were performed (laparoscopic: n = 46, robot-assisted: n = 60). Of these, 74 patients (70%; laparoscopic: n = 28, robot-assisted: n = 46) answered the questionnaire and were included in the evaluation. Continence disorders were reported in a total of 22% of cases. There was no statistically significant difference between the groups in any of the variables surveyed. CONCLUSION With regard to functional results after minimally invasive sigmoid resection for diverticulitis, laparoscopic and robot-assisted sigmoid resection can be considered equivalent procedures.
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Affiliation(s)
| | - Lisa Knörzer
- Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Ulm, Deutschland
| | - Hartmut Dippel
- Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Ulm, Deutschland
| | - Roland Schmidt
- Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Ulm, Deutschland
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