Laparoscopy Decreases Anastomotic Leak Rate in Sigmoid Colectomy for Diverticulitis

Background: Early studies comparing laparoscopic and open operations for diverticulitis failed to show any advantages of the laparoscopic approach. Our study compared the 30-day postoperative outcomes of laparoscopic and open sigmoid colectomy for diverticulitis by surgeons who had performed 20 or more laparoscopic colectomies before the study period. Hypothesis: Patients who undergo an elective laparoscopic operation for diverticulitis have reduced postoperative complications compared with patients who have a traditional open operation. Design: Retrospective analysis. Setting: Academic medical center. Patients: A total of 249 patients who underwent elective open (n = 127) or laparoscopic (n = 122) sigmoid colectomy with primary anastomosis for diverticulitis between July 1, 2001, and February 1, 2008. Main Outcome Measures: Combined rates of free and contained anastomotic leaks.A logistic regression model was used to determine predictors of anastomotic leaks while controlling for significant differences between study groups. Results: Patients who underwent laparoscopic or open operations were similar in age, sex, history of diagnosed intraabdominal abscess (9.4% vs 12.3%), and history of preoperative percutaneous abscess drainage (3.9% vs 4.9%). Patients who underwent the open procedure had a higher Charlson comorbidity index (1.6 vs 1.2; P = .04), and those who underwent laparoscopy more frequently underwent splenic flexure mobilization (82.8% vs 26.7%; P < .001). Patients who underwent a laparoscopy had lower rates of anastomotic leaks (2.4% vs 8.2%; P = .04).This finding held true on logistic regression analysis (odds ratio, 0.67; 95% confidence interval, 0.008-0.567; P = .01), even when controlling for age, Charlson comorbidity index, splenic flexure mobilization, and length of resected bowel. Conclusion: Anastomotic leaks occurred less frequently after laparoscopic sigmoid colectomy performed by experienced laparoscopic colorectal surgeons.