Effectiveness of elective laparoscopic treatment for colonic diverticulitis.

BACKGROUND AND OBJECTIVES: To analyze the short- and long-term outcomes of laparoscopic sigmoid colectomy for the elective treatment of diverticular disease. METHODS: A consecutive unselected series of 94 patients undergoing elective laparoscopic sigmoid colectomy for diverticular disease from 2008 to 2012 was analyzed. We collected patients-, surgery- and hospital stay-related data, as well as the short- and long-term outcomes. Operative steps, instrumentation, and postoperative cares were standardized. Comorbidity was assessed by Charlson comorbidity index. Complications were classified using the Clavien-Dindo classification system. The qualitative long-term assessment was carried out by subjecting patients to the validated gastrointestinal quality of life index questionnaire before and after surgery. RESULTS: The mean age of our cohort was 61.3 ± 11.0 years with a Charlson comorbidity index of 1.2 ± 1.5. Mean operative time was 213.5 ± 60.8 minutes and estimated blood loss was 67.2 ± 94.3 mL. We had 3 cases (3.2%) of conversion to open laparotomy. The rates of postoperative complications were 35.1%, 6.3%, 2.1%, and 1.06%, respectively, for grades 1, 2, 3b, and 5 according to the Clavien-Dindo system. Length of hospital stay was 8.1 ± 1.9 days, and we have not recorded readmissions in patients discharged within 60 days after surgery. Median follow-up was of 9.6 ± 2.7 months. We observed no recurrence of diverticular disease, but there was evidence of 3 cases of incisional hernia (3.19%). The difference between preoperative and late gastrointestinal quality of life index score was statistically significant (97.1 ± 5.8 vs 129.6 ± 8.0). CONCLUSIONS: Elective laparoscopic treatment of colonic diverticular disease represents an effective option that produces adequate postoperative results and ensures a satisfactory functional outcome.

[Totally trans-umbilical laparoscopic cholecystectomy: our experience]. / Colecistectomia laparoscopica con accesso singolo transombelicale: nostra esperienza.

Videoassisted surgery has recently led to a new era, aimed mainly at minimising surgical trauma and improving the cosmetic result. Natural Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS) are emerging as effective techniques whose advantages and possible applications have been widely explored in the most recent literature. Twenty-two consecutive patients, mean age 51.5 years (range: 24-86 years), were subjected to a laparoscopic cholecystectomy through a single, trans-umbilical, incision (SILS). We utilised standard laparoscopic instruments, placing one 10 mm trocar for the camera and two 5 mm trocars for the operative instruments. Mean operative time was 69 min (range: 40 - 120 min). There were no major complications during surgery, and the postoperative recovery was uneventful. All patients referred complete satisfaction with the surgical and cosmetic result obtained 1 and 3 weeks postoperatively.