M. P. DeWane1, A. S. Chiu1, I. Rezek1, K. Y. Pei1 1Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA
Introduction: Small intestine diverticulitis is rare and individual surgeon operative experience is generally limited. As such, optimal surgical management is unknown. This study addresses this knowledge gap by comparing outcomes of laparoscopic versus open operative management of small intestine diverticulitis.
Methods:
This analysis was a retrospective review of the prospectively gathered American College of Surgeons National Surgical Quality Improvement Project from a 5 year period (2010-2014). Patients included for analysis had a primary diagnosis of small intestine diverticulitis (ICD-9 code 562.01) and a primary or secondary procedure listing that indicated bowel resection. Patients were stratified as having undergone either laparoscopic versus open management.
Multivariable logistic regression models controlling for patient variables and comorbidities were constructed to examine risk factors for undergoing extended hospital length of stay (5 days), prolonged operation time (3 hours) or presence of any postoperative complication (including neurologic, cardiac, respiratory, bleeding, renal, infectious, thromboembolic, or wound complications). These models were constructed in a backwards fashion and utilized an inclusion value of 0.1 and significance value p<0.05.
Results: A total of 295 patients were included in this analysis, 22.4% of whom underwent laparoscopic operations. Selected variables and outcomes stratified by cohort are shown in Table I. Emergency cases were more likely to be completed in an open fashion but there were no significant differences in mortality between the operation types. Reoperations were more prevalent in the open cohort. Patients undergoing laparoscopic versus open operation had lower odds of having an extended length of stay (Odds Ratio [OR]: 0.28, p<0.001) and developing any complication (OR: 0.31, p=0.039) and increased odds of undergoing a prolonged operation (OR: 3.67, p<0.001).
Conclusion: Surgical experience for small bowel diverticulitis is rare. Laparoscopic resection performed for small bowel diverticulitis is associated with decreased length of stay and complications. The laparoscopic approach should be considered a safe option in appropriate patients who can tolerate prolonged operations.
