Data from a cohort with 37 patients were retrospectively examined. All patients received surgery because of complicated diverticulitis, either CDD stage 2a or 2b. The patients were divided in two groups according to the timing of operation. Group A (early resection) consisted of 17 electively operated patients (45,9%), while group B (delayed resection) consisted of 20 cases (54,1%). Patients’ characteristics in group A and group B are shown in Table 1.
Table 1
Patient characteristics and indication: Group A: Early resection group; Group B: Delayed resection Group.
| Group A | Group B | p Value |
| n = 17 | n = 20 | |
Sex, Male/Female | 11/6 | 9/11 | |
Age | 56,2 (± 11) | 59,9 (± 12,2) | 0,35 |
BMI | 25,2 (± 2) | 25,4 (± 4,2) | 0,88 |
Comorbidities | 4 (23,5%) | 8 (40,0%) | 0,32 |
Coronary disease | 3 | 3 | 1,00 |
Pulmonary insufficiency | 1 | 1 | 1,00 |
Adipositas | 0 | 2 | 0.49 |
Kidney disease | 0 | 1 | 1,00 |
Hypertension | 0 | 1 | 1,00 |
Diabetes | 0 | 0 | 1,00 |
ASA | | | |
I | 3 (17,6%) | 3 (15,0%) | 1,00 |
II | 11 (64,7%) | 10 (50,0%) | 0.37 |
III | 3 (17,6%) | 7 (35,0%) | 0.29 |
IV | 0 | 0 | 1,00 |
V | 0 | 0 | 1,00 |
Indication: Classification of diveritcular disease-CDD | | | |
2a | 5 (29,4%) | 3 (15,0%) | 0.46 |
2b | 12 (70,6%) | 17 (85,0%) | 0.43 |
Group A consisted of 11 males and 6 females with an average age of 56,2 years (± 11). The average BMI was in this group 25,2 (± 2). Comorbidities were recorded in 23,5% (n = 4) of the patients in this group, the average ASA score was 2. In 70,6% (n = 12) of the cases surgery was indicated because of CDD Stage 2b, 29,4% (n = 5) because of CDD stage 2a.
Group B consisted 9 males and 11 females with a mean age of 59,9 years (± 12). The average BMI was in this group 25,4 (± 4,2). Comorbidities were recorded in 40,0% (n = 8) of the patients in this group, 50,0% (n = 10) were ASA score 2. In 85,0% (n = 17) of the cases surgery was indicated because of CDD stage 2b, 15,0% (n = 3) because of CDD stage 2a.
The data regarding the outcome of both groups are shown in Table 2.
Table 2
Operative Results: Group A: Early resection group; Group B: Delayed resection group. *Summation of all stays ** According to average stay, assumed tariff = 2300 €/d, complications and complicated cases were not included into the calculation.
| Group A | Group B | p Value |
| n = 17 | n = 20 | |
Operation time (min) | 140,4 (± 24,6) | 151,2(± 38,9) | 0,29 |
ICU time (d) | 0 | 0 | |
Duration of hospital stay* (d) | 9,9 (± 2,4) | 16,9 (± 9,6) | 0,01 |
Duration of postoperative hospital stay (d) | 4,8 (± 1,2) | 8,1 (± 4,8) | 0,01 |
Surgical technique: | | | |
Conventional lapaorscopy | 2 (11,8%) | 0 (0,0%) | 0.23 |
Reduced Port | 15 (88,2%) | 20 (100%) | 0.23 |
Conversion to laparotomy: | 0 (0,0%) | 3 (15,0%) | 0,23 |
Intraoperative complications: | 0 (0,0%) | 1 (5,0%) | 1,00 |
Postoperative complications: | 1 (5,9%) | 3 (15,0%) | 0,61 |
Anastomotic leakage | 1 (5,9%) | 2 (10,0%) | 1,00 |
Anastomotic bleeding | 0 (0,0%) | 0 (0,0%) | 1,00 |
Intraabdominal bleeding | 0 (0,0%) | 0 (0,0%) | 1,00 |
Infected haematoma | 0 (0,0%) | 1 (5,0%) | 1,00 |
Clavien-Dindo classification: | | | |
IIIA | 0 | 1 (3,4%) | 1,00 |
IIIB | 1 (5,9%) | 2 (10,0%) | 1,00 |
Re-performing surgery (rate) | 1 (5,9%) | 2 (10,0%) | 1,00 |
Complication management: | | | |
Re-laparocopy + Endo VAC + diverting stoma | 1 | - | 0.46 |
Hartmann procedure | - | 1 | 1,00 |
Re-laparoscopy + diverting stoma | - | 1 | 1,00 |
CT-intervention | - | 1 | 1,00 |
The average operation time was in group A 140,7 minutes (± 24,6), and 151,2 (± 38,9) in group B which was not significant (p = 0,29). In both groups no ICU time was necessary. The total hospital stay differs significantly (p = 0,01). In group A the total hospital stay was 9,9 days (± 2,4), in group B 16,9 days (± 9,6). Also, the postoperative stay was significantly longer in group B than in group A (p = 0,01). In group B we observed a median postoperative stay of 8,1 days (± 4,8), in group A a median postoperative stay of 4,8 days (± 1,2).
88,2% (n = 15) of the cases in group A were operated with reduced port technique, 11,8% (n = 2) in conventional multiport laparoscopic technique. In group B 100,0% (n = 20) were treated with reduced port technique. We observed a conversion rate of 15,0% (n = 3) in group B, no conversions were necessary in group A (p = 0,23). We found no intraoperative complications in group A and one patient with a ureteral injury (5,0%) in group B (p = 1,00). The postoperative complication rate did not differ significantly in both groups (p = 0,61), but we observed more complications in the delayed group. In group A 5,9% (n = 1) suffered a postoperative complication, in group B 15,0% (n = 3). The anastomotic leakage rate was 5,9% (n = 1) in group A and 10% (n = 2) in group B, which was not significant (p = 1,00). Anastomotic bleeding was not observed in both groups, whereas an infected haematoma occurred in one case of group B. Re-laparoscopy plus a diverting ileostomy and Endo VAC was necessary in the case of group A. A Hartmann procedure was performed in one case of anastomotic leakage of group B, the other leakage could be treated laparoscopically with a diverting ileostomy. A CT intervention was indicated in case of the infected haematoma. No patient died in the course of treatment.
Because more complicated diverticulitis cases according CDD stage 2b occured in group B, we analysed also both approaches according to their stage of diverticulitis. Subgroup analysis of CDD stage 2a is shown in table 3, CDD stage 2b is shown in Table 4.
Table 3 Subgroup analysis CDD stage 2a: Group A: Early resection group, group B: Delayed resection Group. *Summation of all stays | Group A | Group B | p Value | | n = 5 | n = 3 | | Operation time (min) | 144,4 (± 15,78) | 158 (± 23,06) | 0,35 | Duration of hospital stay* | 9,8 (± 1,30) | 20,66 (± 11,01) | 0,05 | Duration of postoperative hospital stay (d) | 4,4 (± 0,89) | 15 (± 7,93) | 0,02 | Postoperative complications: | 0 (0,0%) | 2 (66,6%) | 0,11 | Table 4 Subgroup analysis CDD stage 2b: Group A: Early resection group, Group B: Delayed resection Group. *Summation of all stays |
| Group A | Group B | p Value |
| n = 12 | n = 17 | |
Operation time (min) | 138,75 (± 27,97) | 150 (± 36,99) | 0,38 |
Duration of hospital stay* | 10 (± 2,76) | 16,17 (± 9,53) | 0,04 |
Duration of postoperative hospital stay (d) | 5 (± 1,34) | 6,82 (± 3,00) | 0,06 |
Postoperative complications: | 1 (8,3%) | 1 (5,8%) | 1,00 |
The average operation time according the subgroup of CDD stage 2a was 144,4 (± 15,78) in group A and 158 (± 23,06) in group B (p = 0,35). The total hospital stay was 9,8 days (± 1,30) in group A and 20,66 days (± 11,01) in group B, which was significant (p = 0,05). The postoperative stay was 15 days (± 7,93) in group B, whereas in group A the average postoperative stay was 4,4 days (± 0,89) (p = 0,02). This is mainly caused by 2 complications which we observed in the delayed group of CDD stage 2a, and consequently not significant (p = 0,11).
The average operation time according the subgroup of CDD stage 2b was 138,75 (± 27,97) in group A and 150 (± 36,99) in group B (p = 0,38). The total hospital stay was 10 days (± 2,76) in group A and 16,17 days (± 9,53) in group B, which was significant (p = 0,04). The postoperative stay was 6,82 days (± 3,00) in group B, whereas in group A the average postoperative stay was 5 days (± 1,34) (p = 0,06). In both groups one complication occurred (p = 1,00).