Laparoscopic surgery versus open surgery for acute sigmoid diverticulitis

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Laparoscopic surgery versus open surgery for acute sigmoid diverticulitis

Abraha I, Cirocchi R, Binda GA, Montedori A, Arezzo A


Diverticular disease is a condition in which the inner layer of the intestinal wall (mucosa) protrudes through weak points in the muscular layer of the wall, forming small pouches (diverticula) that bulge out of the large bowel. The inflammation of diverticula is defined as diverticulitis. Diverticulitis is more common in the sigmoid colon than in the other tracts of the large bowel. In Western countries, diverticular disease is very common, affecting about 60% of the population over 70 years of age. Most individuals with diverticular disease have no symptoms or experience only mild pain in the lower abdomen, accompanied by a slight change in bowel habits. Individuals with acute diverticulitis may experience pain in the lower abdomen and other symptoms such as fever, nausea, vomiting, and shivering. Diverticulitis generally is treated medically with antibiotics and diet. However, for individuals who experience recurrent abdominal pain or complications, surgical resection of the affected bowel segment is required; this can be performed through conventional open or laparoscopic surgery techniques.

In open surgery, a large abdominal incision is made at the midline to gain access to the abdominal cavity, but via laparoscopy, only small parietal incisions (usually 5 to 12 mm long) are made through the abdominal wall, allowing positioning of gas laparoscopic parietal cannulas (tubes that are inserted into the body) that provide access to the abdominal cavity with long-handled dedicated surgical instruments used under vision of an endoscopic camera. A laparoscopic parietal cannula is a sharp-pointed surgical instrument that is fitted with a tight cannula and is used to insert the tight cannula into a body cavity.

This review addresses the question of whether laparoscopy is more effective and/or safer than open surgery in the treatment of individuals with diverticulitis of the sigmoid colon who require a surgical resection.

Study characteristics

We identified three trials that compared the efficacy of laparoscopic surgery and open surgery. These studies included 392 participants (195 in the laparoscopic group vs 197 in the open surgery group). The method used to allocate participants based on randomisation, that is, the choice of treatment that participants received, was determined by a method similar to coin tossing, so the two groups were as similar as possible.

Key findings

We found that laparoscopic surgical resection may lead to little or no difference in mean hospital stay when compared with open surgical resection. Operating time was longer in the laparoscopic group by an average of 49 minutes. No important differences were observed in terms of 30-day postoperative mortality, early overall morbidity, major and minor complications, surgical complications, postoperative times to liquid and solid diets, and reoperations due to anastomotic leak. To assess quality of life, researchers used different scales at different periods of time. Although one trial reported that patients who received laparoscopic surgery had better quality of life, the other two trials showed no benefit favouring either laparoscopic surgery or open surgery.

Quality of the evidence

The quality of the evidence varied from low to very low owing to risk of bias (i.e. conclusions may overestimate benefits or underestimate harms because of biased study design and conduct) and limitations in the patient population sample. Well-designed trials are necessary to obtain a more accurate estimate of the benefits and safety of laparoscopic surgery over open surgery.

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