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Laparoscopic sigmoid resection for diverticular disease has no advantages over open approach: midterm results of a randomized controlled trial

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Abstract

Purpose

Elective laparoscopic sigmoid resection (LSR) for symptomatic diverticular disease is supposed to have significant short-term advantages compared to open surgery (open sigmoid resection (OSR)). This opinion is rather based on inferences from trials on colonic resections for malignant diseases or minor laparoscopic surgery. This randomized controlled trial was conducted to compare quality of life as well as morbidity and clinical outcome after LSR vs. OSR following a midterm follow-up period.

Methods

Patients presenting with a symptomatic sigmoid diverticular disease stage II/III (Stock/Hansen) were randomly allocated to LSR or OSR in a prospective multicenter trial. Endpoints included the quality of life assessed with a standardized questionnaire, postoperative mortality, and complications within the follow-up of 12 months after operation.

Results

A total of 143 patients randomized between 2005 and 2008 in 12 centers could be analyzed. The recruitment was aborted for nonachievement of the planned sample size. Seventy-five patients were allocated to LSR, and 68 received OSR. Nine operations were converted to OSR (9%) and analyzed as intention to treat. Groups were comparable for age, gender, body mass index, comorbidity, and indication for surgery. Operation time was longer for LSR (p < 0.001). Quality of life did not differ between LSR and OSR, either during the early postoperative course or after 12 months (p = 0.172). Also, mortality and morbidity, including subgroups of major and minor morbidity, were compared.

Conclusion

LSR was not superior to OSR regarding postoperative quality of life and incidence of complications in this trial.

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Acknowledgments

The following hospitals participated in the LAPDIV-CAMIC trial by randomizing patients: Charité–University Medicine Berlin, Campus Mitte (Prof. J.M. Mueller), Charité–University Medicine Berlin, Campus Virchow Klinikum (Prof. P. Neuhaus), Marienhospital Stuttgart (Prof. R. Bittner), Klinikum Suedstadt, Rostock (Prof. K. Ludwig), Krankenhaus St. Elisabeth und St. Barbara Halle/Saale (Dr. W. Asperger), HELIOS Klinikum Aue (Dr. R. Albrecht), Universitätsklinikum Heidelberg (Prof. M. Buechler), Ludwig-Maximilians-University Munich (Prof. K.W. Jauch), Diakoniekrankenhaus Rothenburg/Wuemme (Prof. H.F. Weiser), Sana Klinikum Berlin Lichtenberg (Prof. K. Gellert), Ketteler-Krankenhaus Offenbach (Prof. V. Paolucci), DRK-Kliniken–Berlin Koepenick (Prof. M. Pross), Charité–University Medicine Berlin, Campus Benjamin Franklin (Prof. H.-J. Buhr).

Funding

This work was supported by the Charité–University Medicine Berlin. No funding was received from other organizations.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of General, Visceral, Vascular and Thoracic Surgery, Charité–University Medicine Berlin, Campus Mitte, Berlin, Germany

    Wieland Raue

  2. Department of General and Visceral Surgery, Ketteler Krankenhaus Offenbach, Offenbach, Germany

    V. Paolucci

  3. Department of General and Visceral Surgery, Krankenhaus St. Elisabeth u. St. Barbara Halle, Halle, Germany

    W. Asperger

  4. Department of Visceral and Vascular Surgery, HELIOS Klinikum Aue, Erfurt, Germany

    R. Albrecht

  5. Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany

    M. W. Büchler

  6. Department of General and Visceral Surgery, Asklepios Klinik Altona, Hamburg, Germany

    W. Schwenk

  7. Klinik für Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Wieland Raue

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Correspondence to Wieland Raue.

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Raue, W., Paolucci, V., Asperger, W. et al. Laparoscopic sigmoid resection for diverticular disease has no advantages over open approach: midterm results of a randomized controlled trial. Langenbecks Arch Surg 396, 973–980 (2011). https://doi.org/10.1007/s00423-011-0825-4

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