Impacto de la subespecialización en los resultados de la sigmoidectomía laparoscópica por diverticulitis perforada Hinchey III

Nicolás H.  Dreifuss; Francisco  Schlottmann; María A.  Casas; Maximiliano E.  Bun; Nicolás A.  Rotholtz

doi:10.46768/racp.v31i3.72

Nicolás H. Dreifuss Departmento de Cirugía, Hospital Alemán de Buenos Aires. CABA, Argentina
Francisco Schlottmann Departmento de Cirugía, Hospital Alemán de Buenos Aires. CABA, Argentina.
María A. Casas Departmento de Cirugía, Hospital Alemán de Buenos Aires. CABA, Argentina
Maximiliano E. Bun Departmento de Cirugía, Hospital Alemán de Buenos Aires. CABA, Argentina.
Nicolás A. Rotholtz División de Cirugía Colorrectal, Hospital Alemán de Buenos Aires. CABA, Argentina

DOI: https://doi.org/10.46768/racp.v31i3.72

Keywords: perforated diverticulitis, Hinchey III, colorectal surgery, laparoscopic surgery

Abstract

Background: Sigmoid resection for perforated diverticulitis is one of the most common emergency surgeries and often performed by general surgeons. Relationship between high-volume surgeons and improved postoperative outcomes is well established. However, the influence of colorectal specialization on outcomes after emergency laparoscopic sigmoidectomy for perforated diverticulitis is not well described.
Aim: Evaluate the impact of colorectal surgery training on the outcomes after emergency laparoscopic sigmoid resection for Hinchey III diverticulitis.
Design: Retrospective analysis of prospectively collected database.
Method: Patients undergoing emergent laparoscopic sigmoid resection for perforated (Hinchey III) diverticulitis were identified and stratified by involvement of colorectal or general surgeon. This study was conducted from 2000 to 2018 at a teaching hospital. Primary outcome measures were primary anastomosis, postoperative morbidity and mortality.
Results: A total of 101 patients were identified; 58 by colorectal and 43 by general surgeons. Patients in the colorectal surgeon group had higher rates of primary anastomosis (CS: 98, 2% vs. GS: 67, 4%, p<0.001). General surgeons performed more ostomies (CS: 13, 8% vs. GS: 46, 5%, p<0.001), had a higher conversion rate (CS: 20, 6% vs. GS: 39, 5%, p=0.03) and longer mean length of hospital stay (CS: 6, 2 vs. GS: 10, 8 days, p<0.001). Overall morbidity (CS: 34, 4% vs. GS: 46, 5%, p=0.22), anastomotic leak rate (CC: 3,5% vs. CG: 6,8%, p=0.48) and mortality (CS: 1, 7% vs. GS: 9,3 %, p=0.08) were similar between groups.
Conclusion: Emergency laparoscopic sigmoid resection by general surgeons wasn´t associated with higher rates of postoperative morbidity, anastomotic leakage or mortality. However, patients operated by colorectal surgeons had higher rates of primary anastomosis, lower rates of ostomy, conversion and shorter length of hospital stay.