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João Odilo Gonçalves Pinto et al
World Journal of Laparoscopic Surgery, September-December 2008;1(3):22-27
Elective Laparoscopic Left Colectomy for

Diverticular Disease: A Monocentric Study on

205 Consecutive Patients

2
1
1 João Odilo Gonçalves Pinto, Basmah Fallatah, Phillipe Espalieu, Gilles Poncet, Alvine Bissery
1
1
1 Jean-Claude Boulez
1 Department of General and Digestive Surgery, Edouard Herriot Hospital, University Claude Bernard Lyon 01–Lyon, France
2 Department of Biostatistics, Hospices Civils de Lyon, University Claude Bernard Lyon 01 – Lyon, France
Correspondence: Pr Jean-Claude Boulez. Hôpital Edouard Herriot, Service de Chirurgie Digestive–Pavillon D4, Place d’Arsonval,
69437 Lyon CEDEX 03, Telephone : +33 472110107, Fax: +33 472116252
E-mail: jean-claude.boulez@chu-lyon.fr

Abstract patient; (4) diverticular disease complicated with bleeding;
This study was aimed to analyze the outcomes of laparoscopic (5) diverticular disease with associated lesions of surgical
colectomy for diverticular disease performed over a 17 year period at treatment such as the colonic neoplasms. Although uniformly
a single institution. Between April 1990 and May 2007. followed in our surgical unit, those indications varied along the
years and could be anticipated or postponed according to the
Keywords: Diverticular disease; laparoscopic colectomy; diverticulitis.
medical consultants’ referrals. After an episode of complicated
MATERIALS AND METHODS diverticulitis, whether or not an invasive procedure was needed,
an interval of at least one month was respected before the
Population elective operation was scheduled (Table 1).
Between April 1990 and May 2007, a total of 210 elective
laparoscopic colonic resections for diverticular disease were Surgical Technique
performed at the D4 Unit of General and Digestive Surgery at A total laparoscopic operative technique was used in which a
the Edouard Herriot Hospital – Lyon, France. This study inclu- stapled intra-abdominal anastomosis is made. The resected
ded the 205 left colectomy procedures comprising 185 sigmoi- specimen is removed through a small prolongation of a 12 mm
dectomies (90, 24%) and 20 left hemicolectomies (9,76%). The left lower quadrant (LLQ) trocar incision, occasion that is profited
three right colectomies and two total colectomies were excluded. to place a circular stapler anvil into the descending colon stump
Patients were first referred for surgical consultation either
from the gastroenterology department consultants, the at the same time. The stapler is then passed through the anus to
complete the anastomosis after closing the small incision and
community physicians or the emergency department. Pertinent
information was then collected in a comprehensive sheet re-establishing the pneumoperitonium. Some variations were
throughout preoperative consultations, subsequent hospi- tried at the beginning of the experience with the removal incision
talizations and postoperative follow-up. Data were later entered being used either to insert a hand-port (15 cases) or to manually
into a computer database and updated every time new perform the anastomosis in a laparoscopic-assisted technique
information was obtained. Those included the patient’s (7 cases). The procedure is performed with the surgeon placed
antecedents, mode of presentation, surgical indications, pre- on the right side of the patient and with the aid of four trocars.
operative work-up, details of the operative procedure, com- In 158 (77,07%) cases, it was judged necessary to release the
plications, hospital stay, mortality and follow-up results. splenic flexure of the colon. In those occasions, the procedure
Usual surgical indications were: (1) after a documented was started with the surgeon placed between the legs of the
diagnosis of complicated diverticulitis either acute or chronic patient and an additional 5 mm trocar could be placed. An
(abscess, perforation, fistula, stenosis); (2) after the second aspirative drain was placed most of the time (96,1% of cases)
non-complicated acute attack of diverticulitis; (3) after the first and a protection colostomy was rarely necessary (03 cases).
non-complicated acute attack of diverticulitis in special situa- The steps sequence of the operation are as follows:
tions such as the patient aged < 50 years and immunosuppressed (1) release of the splenic flexure of the colon (when necessary

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