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Aim Methods Results Conclusions The purpose of this study was to assess the utility of routine histopathological examination in patients undergoing elective sigmoidectomy for diverticular disease after full colonoscopy 1 year prior to surgery.We retrospectively analysed medical records of all patients undergoing sigmoidectomy for diverticular disease with a documented colonoscopy within 1 year before surgery from January 2013 to December 2023. We collected preoperative, intraoperative and postoperative data of all patients. The primary endpoint was the percentage of patients with an unexpectedly abnormal histopathological report compared to colonoscopy.During the study period, 207 patients undergoing sigmoidectomy for diverticular disease were included. Mean age was 62.7 ± 13.0 years and 97 (46.9%) patients were men. In eight (3.9%) cases an unexpected finding was noted on the histopathological examination: five (2.4%) of them were hyperplastic polyps with no dysplasia and no clinical relevance, two (1.0%) were polyps with low‐grade dysplasia and in one case (0.5%) a diffuse large B‐cell lymphoma was present in a patient with history of lymphoma treated in the past 10 years. The Goodman and Kruskal's G index was 0.953 (95% lower limit of 0.913), which indicated high concordance between the colonoscopy and the definitive histopathological examination.In our series, the preoperative colonoscopy reliably predicted the result of the histopathological specimen findings in patients undergoing sigmoidectomy for diverticular disease. Only one (0.5%) high‐risk patient had an unexpected clinically significant finding. Therefore, routine histopathological examination may not be justified for all patients. [ABSTRACT FROM AUTHOR]

Aim: Extraperitoneal sigmoidopexy is a simple, safe and effective non‐resective procedure with minimal morbidity and mortality rates. Patients and Methods: This prospective comparative study involved 105 patients with uncomplicated sigmoid volvulus at Asyut University Hospitals, Egypt, from June 2021 to January 2023. The study population was divided into two groups: Group A, which underwent extraperitoneal sigmoidopexy, and Group B, which was treated with sigmoidectomy and primary anastomosis. Results: The study included 105 cases. A total of 56 (53.4%) patients underwent extraperitoneal sigmoidopexy (Group A) and 49 (46.6%) patients underwent sigmoidectomy (Group B). The mean age was 61.33 (standard deviation [SD] 1.65) for Group A and 67.9 (SD 1.69) for Group B (P =.36). The mean operative time (minutes) was 62.25 (SD 1.38) for Group A and 87.60 (SD 2.38) for Group B (P <.0001). The mean hospital stay (days) was 6.25 (SD 0.29) for Group A and 9.04 (SD 0.34) for Group B (P <.0001). There was a significant difference in overall morbidity and recurrence rate, while no significant difference was observed in intensive care unit admission, additional surgery and mortality between the two groups. Conclusion: Extraperitoneal sigmoidopexy emerges as a simple, safe and effective treatment option for non‐complicated sigmoid volvulus. Despite a higher recurrence rate, it demonstrates lower morbidity and mortality compared with sigmoidectomy. [ABSTRACT FROM AUTHOR]

Aim: A sigmoidectomy is the most definitive surgical treatment for recurrent diverticulitis. While it is usually accomplished via transabdominal specimen extraction and stapled anastomosis, the robotic platform can facilitate novel approaches and techniques. This is the first report of the initial experience using robotic sigmoidectomy with natural orifice specimen extraction and hand‐sewn anastomosis (NOSHA). Method: A prospectively maintained database of NOSHA procedures performed between 2018 and 2020 was retrospectively examined. The technique was described and variables across preoperative, intra‐operative and postoperative timeframes were presented. The Clavien‐Dindo classification system was used to describe postoperative complications. Results: Sixteen patients with recurrent diverticulitis treated with NOSHA were included in this study. Transanal specimen extraction and an intracorporeal hand‐sewn anastomosis were achieved in all patients. However, two (12.8%) patients required specimen debulking prior to extraction. The mean operating time was 171.7 min, and patients had a return of bowel function within an average period of 35.2 h. The mean hospital length of stay was 2.9 days. In total, two (12.8%) complications were seen: one postoperative ileus managed conservatively and one readmission for abdominal pain which resolved without intervention. No anastomotic leaks or reoperations were observed. Conclusion: Robotic NOSHA appears to be a viable technique for the surgical management of diverticulitis. Further studies are needed to establish its utility for various diseases and its reproducibility across clinical practices. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to analyse the role of inferior mesenteric artery (IMA) ligation during elective colonic resection for diverticular disease (DD) with respect to surgical outcome. Methods: All patients who underwent elective laparoscopic or open colonic resection for DD from January 2006 to December 2012 were studied. The patients were divided into two groups based on IMA ligation or preservation. The primary end point was to compare anastomotic leakage in the two groups. The secondary end points were operative time, stoma formation, overall post‐operative complications, restoration of bowel function and length of post‐operative hospital stay. Results: During the study period, 219 elective colonic resections with primary anastomosis for DD were performed. A laparoscopic technique was employed in 132 (60.3%) cases. IMA ligation was performed in 66 patients (30.1%). Overall anastomotic leakage rate was 4.1%, 4.5% in IMA ligation and 3.9% in IMA preservation group, respectively (P = ns). Mean operative time was 225 ± 43.4 and 191 ± 41.7 min in IMA ligation and preservation group, respectively (P = 0.002). No differences were observed in the rate of overall complications, stoma formation, restoration of bowel function and post‐operative length of hospital stay. Conclusions: No differences were observed in surgical outcome in IMA ligation and preservation groups, particularly preservation or ligation of the IMA did not affect leakage rate. [ABSTRACT FROM AUTHOR]

Aim The postoperative outcome after elective sigmoidectomy for diverticulitis has not been compared to that for cancer. The study aimed to evaluate the differences in the postoperative outcome after sigmoidectomy for diverticular disease and cancer. Method The National Inpatient Sample Database was used to identify patients who underwent elective sigmoid resection for diverticular disease or cancer between 2004 and 2011. After excluding patients with metastatic cancer and preoperative weight loss, sigmoid cancer and diverticulitis patients were matched using propensity score, controlling for age, gender, race, type of operation (open vs laparoscopic) and comorbidities. The end-points of interest were infective complications, reoperation, anastomotic leakage, rebleeding, length of hospital stay and in-hospital mortality. Results After propensity score matching (diverticulitis 11 192 patients, sigmoid cancer 11 192 patients), the mean age was 65 ± 12.5 years, 53.8% were male and 61.5% were Caucasian. Only 18.0% of the operations were done by laparoscopy. The overall complication rate was 17.7% and the in-hospital mortality rate was 0.9%. The diverticulitis group had a higher rate of surgical site infection (3.2% vs 2.6%, P = 0.004), intra-abdominal abscess formation (1.2% vs 0.4%, P < 0.0001) and reoperation (6.1% vs 4.1%, P < 0.0001) compared with the cancer group. The cancer group had a higher incidence of pneumonia (1.9% vs 1.5%, P = 0.01) and anastomotic leakage (9.2% vs 8.3%, P = 0.001). There was no difference in sepsis, deep vein thrombosis, respiratory failure, renal failure, rebleeding, overall complication rate or length of hospital stay. Subgroup analysis showed a higher in-hospital mortality for cancer than for diverticulitis patients whether resected by open or by laparoscopic surgery. Conclusion Although elective sigmoidectomy for diverticular disease has a higher risk of infective complications, elective sigmoidectomy for cancer has a higher risk of anastomotic leakage. [ABSTRACT FROM AUTHOR]

Aim A meta-analysis was conducted to compare preservation with ligation of the inferior mesenteric artery (IMA) during sigmoidectomy for diverticular disease. Method Randomized and non-randomized clinical trials were identified using the following electronic databases: Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, Science Citation Index, Greynet, SIGLE, National Technological Information Service, British Library Integrated Catalogue. The analysed end-points were the anastomotic leakage rate, overall morbidity and 30-day postoperative mortality. Results Four studies were included involving 400 patients. The anastomotic leakage rate was 7.3% in the preservation group and 11.3% in the ligation group. There was no statistically significant difference between the groups (OR 0.72, 95% CI 0.11-4.76; P = 0.73). Overall morbidity and 30-day postoperative mortality were not compared since these data were reported in only one study. Conclusion The meta-analysis did not show any advantage for preservation of the IMA during sigmoid colectomy for diverticular disease in terms of anastomotic leakage. [ABSTRACT FROM AUTHOR]

Background Transumbilical single incision laparoscopic surgery (SILS) has made its initial forays into clinical minimally invasive surgery. SILS combines in part the cosmetic advantage and decrease parietal trauma of natural orifice surgery, but allow operative realization with standard and validated laparoscopic instruments. We report here the first clinical transumbilical SILS sigmoidectomy for benign disease. Method Preliminary experience with transumbilical single incision laparoscopic surgery (or embryonic natural orifice transluminal endoscopic surgery) sigmoidectomy in a female patient (34 years, BMI 22 kg/m2) with sigmoid stenosis caused by nodular endometriosis was reported. Transumbilical SILS treatment of pelvic endometriosis was performed during the same operation through cauterization. Results Transumbilical single incision laparoscopic sigmoidectomy was feasible with conventional laparoscopic instruments. The combined uses of straight and articulated laparoscopic instruments allow the avoidance of transparietal sling suture for exposition. Operative time for sigmoidectomy and endometriosis therapy was 125 min. No intra-operative or postoperative complications were recorded. SILS achieved excellent cosmetic results and may be associated with accelerated recovery. Conclusion Transumbilical single incision laparoscopic sigmoidectomy is feasible by experienced laparoscopic surgeons using conventional laparoscopic instruments and staplers. The combined uses of strait and articulated instruments allow transumbilical SILS sigmoidectomy without the need for additional incision or transparietal sling suture. SILS sigmoidectomy may have the clinical advantage over NOTES of offering the safety of laparoscopic colectomy and the avoidance of vaginal access. It has to be determined if SILS offers benefit to the patient, except in cosmesis, compared with standard laparoscopic sigmoidectomy. [ABSTRACT FROM AUTHOR]

Ligation of the inferior mesenteric artery (IMA) during sigmoid colectomy may cause sympathetic denervation of the rectal stump. The purpose of our study was to investigate the functional results after sigmoid resection following ligation or preservation of the IMA. We prospectively analysed 44 patients (21 female and 23 male, mean age 60.6 ± 11.79 years) with sigmoid tumour. Sigmoid colectomy with preservation of the IMA was performed in 21 patients, and ligation of the IMA with sigmoidectomy was carried out in 23 patients. Bowel function follow-up was performed by use of questionnaires: standardized functional questionnaire, constipation-specific, and incontinence scales before, 6 and 12 months after surgery. The quality of life was measured by means of the Fecal Incontinence Quality of Life (FIQL) scale. After sigmoid colectomy with division of the IMA, patients presented with a higher rate of fecal incontinence and increased stool frequency compared with patients after sigmoid resection with preservation of the IMA. Deterioration of FIQL was also observed in patients with ligated IMA. Preservation of the IMA during sigmoid colectomy in selected patients lowers the frequency of postoperative impaired anorectal function. [ABSTRACT FROM AUTHOR]

Objective: To describe the use of mechanical anastomoses in cases of laparoscopically assisted vaginal rectosigmoidectomy for the treatment of rectosigmoid endometriosis.Methods: Pilot study evaluating eight patients with rectosigmoid endometriosis referred for surgical treatment. All patients were submitted to laparoscopically assisted vaginal segmental resection of the rectosigmoid with anastomoses performed using linear and circular staplers.Results: The average length of the surgical procedure was 177.5 min and average duration of hospitalization was 4.13 days. There were no intra-operative complications and integrity of the anastomoses was confirmed in all patients. One patient reported partial improvement of symptoms and 7 patients presented complete clinical remission 12 months following surgery.Conclusion: Laparoscopically assisted vaginal segmental resection of the sigmoid infiltrated by endometriosis is a feasible surgical procedure. The technique combines transvaginal access with mechanical intestinal anastomoses performed using linear and circular staplers, and achieves good results with low morbidity. [ABSTRACT FROM AUTHOR]