Abstract |
Introduction Laparoscopic (LAP) colectomy is now the "gold" standard for diverticulitis; the role of hand-assisted LAP (HAL) and Open methods today is unclear. This study assessed the elective use of these methods for diverticulitis. Methods A retrospective review of demographic, comorbidity (Carlson Comorbidity Index [CCI]), resection type, and short-term outcomes was carried out. Results There were 125 (44.5%) LAP, 125 (44.5%) HAL, and 31 (11%) Open cases (overall N = 281). The mean age, body mass index, and percentage of high-risk patients (CCI score >2) of the HAL group were greater (P < .05) than the LAP group (vs Open, P = ns). The Open group's mean age and percent with CCI >2 was greater when compared with the LAP group (P < .05). More Open (P < .05) and HAL patients had complex disease (Open, 63%; HAL, 40%, LAP, 22%) and were diverted (Open, 35%; HAL, 10%; LAP, 3%). Time to bowel movement was not different; however, there was a stepwise increase in median length of stay (LOS; days) from the LAP (5 days) to HAL (6 days) to Open group (7 days) (P < .05 for all). The LAP complication rate (22.4%) was lower (P < .05) than the HAL (42.4%) or Open groups' (45.2%) rates. The LAP surgical site infection rate (5.6%) was lower (P < .05) than the HAL (12.8%) or Open groups (19.6%). Conclusion The HAL and Open groups had more high risk, complex disease, diverted, and older patients than the LAP group; likewise, the overall complication rate and LOS was higher in the HAL and Open groups. Use of HAL methods likely contributed to the high minimally invasive surgery utilization rate (89%).
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Authors | Hiromichi Miyagaki, Rebecca Rhee, H M C Shantha Kumara, Xiaohong Yan, Linda Njoh, Vesna Cekic, Richard L Whelan |
Journal | Surgical innovation
(Surg Innov)
Vol. 23
Issue 3
Pg. 277-83
(Jun 2016)
ISSN: 1553-3514 [Electronic] United States |
PMID | 26611789
(Publication Type: Journal Article)
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Copyright | © The Author(s) 2015. |
Topics |
- Adult
- Aged
- Colectomy
(adverse effects, methods)
- Databases, Factual
- Diverticulitis
(diagnosis, surgery)
- Diverticulum, Colon
(complications, surgery)
- Elective Surgical Procedures
(adverse effects, methods)
- Female
- Follow-Up Studies
- Hand-Assisted Laparoscopy
(adverse effects, methods)
- Hospitalization
(statistics & numerical data)
- Humans
- Length of Stay
- Logistic Models
- Male
- Middle Aged
- Multivariate Analysis
- Postoperative Complications
(epidemiology, physiopathology)
- Retrospective Studies
- Risk Assessment
- Statistics, Nonparametric
- Treatment Outcome
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