The current trend to treat recurrent episodes of diverticulitis with surgery is becoming more acceptable, especially in the younger patient, aged under 50 years. Many centres worldwide have adopted laparoscopic elective surgery for recurrent diverticulitis. This prevents the risk of complicated diverticulitis with perforation and the emergency laparotomy and Hartmann's procedure, which have a mortality and morbidity consequence. With the current trend of early discharge after surgery and the pressure on beds, an elective operation should produce a quicker turn-round than emergency surgery with its postoperative complications (Gonzalez et al., 2003). Laparoscopic surgery can be used for patients of all ages after the patient's assessment for suitability.
Laparoscopic or keyhole surgery is a minimally invasive procedure and recovery is therefore quicker. There will be a number of times that the procedure needs to be converted into a standard laparotomy. The rationale for this may be previous abdominal surgery that has resulted in adhesions, the surgeon may decide that it is not safe to proceed with the laparoscopic surgery or the operation may be technically impossible. The patient would require counselling from the specialist nurse about the surgery and the possibility of having the laparoscopic operation converted into a conventional one. The patient may also need to be sited for a possible stoma as a precaution.
The operation involves five or six small incisions instead of the usual laparotomy incision. These incisions allow the surgeon to insert the laparoscope and instruments to be passed into the abdomen. The surgeon would then be able to see what he is doing via the picture transmitted from the scope to a television screen. The surgeon is always able to decide whether to proceed with the full laparoscopic procedure once he has visualized the inside of the abdominal cavity.
The laparoscopic resection is not a faster method of surgery and one concern is the length of time that the procedure takes as opposed to conventional laparotomy. A study carried out by Dwivedi et al. (2002) concluded that the surgery time taken for performing the laparoscopic sigmoid colectomy was decreasing as surgeons gained more experience. The procedure was also seen to be a reliable and efficacious treatment with better outcomes for sigmoid diverticular disease of the sigmoid colon.
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