S. R. Sprinkle1, Z. Sun1, M. A. Adam1, J. Kim1, B. A. Yerokun1, J. Migaly1, C. R. Mantyh1 1Duke University Medical Center,Department Of Surgery,Durham, NC, USA
Introduction:
Diverticulitis represents a common disease that is routinely treated by surgical resection. Although the laparoscopic approach is favored, some authors have raised concerns that conversion to an open surgery results in outcomes that are inferior to both laparoscopic and open procedures. However, these published reports are limited by small sample sizes and lack of generalizability. Using a large risk-stratified database, this study examines the effect on outcomes of conversion from a minimally invasive to an open procedure for diverticulitis.
Methods:
Adult patients from the 2012-2013 Colectomy-Targeted National Surgical Quality Improvement Program (NSQIP) database who underwent elective segmental colectomy for diverticulitis were grouped by completed surgical approach: minimally invasive surgery (MIS), MIS converted to open, and planned open surgery. Multivariable regression methods were utilized to evaluate the effect of conversion on perioperative outcomes.
Results:
Among 3,263 patients included, 2,272 (70%) underwent MIS, 276 (8%) had MIS converted to open surgery, and 715 (22%) had planned open surgery. Age was the only independent predictor of conversion (adjusted odds ratio [OR] 1.016, p < 0.01). After adjusting for demographic, clinical, and treatment factors, there were no significant differences in overall complications, postoperative ileus, anastomotic leak, readmission, or reoperation between converted and planned open surgeries. The conversion group had a decrease in length of stay (-0.4 days, 95% CI -0.6 to -0.2) but an increase in wound complications (OR 1.55, 95% CI 1.08 – 2.24) (all p <0.05). MIS was associated with a significant reduction in overall complications (OR 0.49, 95% CI 0.38 – 0.63), ileus (OR 0.37, 95% CI 0.28 – 0.50), readmission (OR 0.71, 95% CI 0.51 – 0.99), length of stay (-1.2 days, 95% CI -1.3 to -1.1) and wound complications (OR 0.61, 95% CI 0.46 – 0.81) when compared to converted procedures (all p<0.05).
Conclusion:
Using the most recent NSQIP colorectal database, laparoscopic conversion to open surgery for diverticulitis does not result in worse overall outcomes than a standard open approach. However, completing the procedure laparoscopically is associated with significant perioperative benefits compared to converted or planned open surgery. This suggests that an attempt at laparoscopic resection should be strongly considered for all patients with diverticular disease.
