What is the optimal time of surgical intervention after an acute attack of sigmoid diverticulitis: Early or late elective laparoscopic resection?

PURPOSE: This prospective study was designed to check the ideal time of surgical intervention by comparing the results of early elective laparoscopic sigmoid resection after an inflammatory attack with those of late elective resection during the inflammation-free interval. METHODS: A total of 210 patients ( 114 males) underwent laparoscopic resection for acute sigmoid diverticulitis between 1999 and 2005. They were prospectively divided into two groups: Group I with an early elective sigmoid resection ( 5 - 8 days after initial antibiotic treatment); Group II in the inflammation-free interval ( 4 - 6 weeks after initial hospitalization). RESULTS: There was no difference between the groups with regard to age (55.7 years), American Society of Anesthesiologists score (1.86), previous diseases, and extent of inflammation. After surgery, 156 patients (74.3 percent) were complication-free. There was a total of ten conversions ( Group I, 9; Group II, 1; P < 0.05). Minor complications developed in 42 patients ( abdominal wall abscess = 24, intestinal atony = 6, hematoma = 9, urinary tract infection = 2). Eight patients in Group I ( P < 0.05) developed anastomotic leaks. None of the patients died. CONCLUSIONS: In the majority of patients, laparoscopic sigmoid resection in sigmoid diverticulitis can be performed without conversion. Patients who underwent surgery in the inflammation-free interval had a lower complication rate than those submitted to early elective resection. In our patient population, we were able to show that surgery in the inflammation-free interval significantly reduces postoperative morbidity. It is thus preferable for patients with sigmoid diverticulitis to receive initial antibiotic treatment and then undergo late elective laparoscopic sigmoid resection.