colonic diverticulosis is a very frequent disease in the west . in 40- to 50-year - old persons , its incidence increases with age , reaching over 50% in persons > 70 . in most cases ( 80% ) ,
the disease is asymptomatic ( diverticulosis ) and has a mild functional clinical scenario of dyscinesia .
a few patients , about 10% to 20% , have simplex acute or complicated diverticulitis ( perforation , abscess , fistula , hemorrhage , circumscribed or generalized peritonitis ) .
laparoscopy has been used to treat diverticular disease , and currently it is a widely accepted and used procedure .
the laparoscopic approach is not commonly used to treat neoplastic pathology of the colon - rectus ; however , its use is not restricted in treating phlogistic diseases .
in fact , data about the feasibility and advantages of the laparoscopic approach for treating diverticular disease are reported in the literature . greater postoperative comfort , with a reduction in pain and lower need for analgesics , a more rapid resumption of intestinal function , a shorter hospital stay , and a more rapid return to social activity
between january 1999 and january 2001 , 5 patients underwent elective treatment with the laparoscopic approach for uncomplicated diverticulitis .
the phases of the procedure were the usual : mobilization of the left colon , isolation and section of the inferior mesenteric artery , sovrapubic incision for operative specimen removal , preparation of the proximal stump , closure of the distal stump with endo - gia , and end - to - end intracorporeal coloproctostomy with a circular stapler . in the preceding period ( september 1997 through december 1998 ) ,
the surgical indication , always elective , was determined on the second admission for acute and obviously uncomplicated diverticulitis .
the classifications of diverticular disease according to hinchey and wexner are shown in table 1 .
classification of diverticular disease according to hinchey and wexner the symptomatology is characterized by fever , leukocytosis , nausea , vomiting , pain , and medium - degree contracture of defense in the inferior left abdominal quadrant . a mass in the lower abdominal quadrants or an extensive contracture of defense , except for the left inferior quadrant
if either is present , emergency surgery should be performed because of the presence of an abscess or circumscribed or generalized peritonitis from a micro or macro diverticular perforation .
the elements of the clinical scenario of our patients enrolled in the study are outlined in table 2 .
we compared the results of the surgical treatment in both groups of patients ( table 3 ) .
the number of patients and the demographic data ( sex , age ) are similar .
postoperative morbidity ( anastomotic dehiscences , wound infections , bronchopneumonic infiltrates ) and mortality ( within 30 days ) are the same for both groups . on the contrary ,
the following elements are in evidence : a more rapid resumption of bowel movement and alimentation , with a precocious ambulation , and a shorter hospital stay in the patients who underwent the laparoscopic intervention . as to these facts ,
, we can affirm that , even without statistical validation , on the basis of the results obtained , with the same incidence of morbidity , the elective laparoscopic approach to colectomy for diverticulitis has a more rapid and comfortable postoperative course .
surgery has a pre - eminent role on the general therapeutic plan when a benign , uncomplicated pathology is to be treated .
we think that surgery should not be performed to treat simple diverticulitis when no inflammatory episodes have occurred .
the appearance of acute diverticulitis in the fourth , fifth , and sixth decades represents a further favorable element for surgical indication .
moreover , episodes of acute diverticulitis are considered uncomplicated if medical therapy , begun early , leads to improvement in the clinical scenario within 48 hours . in our opinion , medical therapy must be effective quickly , resulting in improved symptoms within 48 hours . with the persistence or worsening of symptoms
the medical therapy used is based on cessation of solid and liquid food intake , on absolute intestinal rest , on hydro - electrolyte reintegration , and on the use of broadspectrum parenteral antibiotics and analgesics .
the clinical scenario must be evaluated quantitatively and qualitatively because the same signs with different degrees of expression can change the indication from medical therapy to urgent surgical therapy .
moreover , comparison of the 2 surgical approaches ( laparoscopic - assisted vs. open ) must not improperly influence the choice between surgical and medical therapy , in the symptomatic but uncomplicated phase of the disease .
surgery , almost always performed urgently , is necessary in cases of complicated acute diverticulitis , such as pericolic abscess , perforation , circumscribed or generalized peritonitis , and fistulization .
however , even in these cases , the possibility of a laparoscopic approach can be considered .
our cases fall within stage i of the hinchey - wexner classification , both in the laparoscopic and open exploration groups , excluding the cases of complicated diverticulitis ( abscess , fistula , perforation , generalized peritonitis ) in this study . in our opinion ,
great effort must be made not to change the clinical criteria for the indication because of the sometimes good results of the laparoscopic approach .
then , the question that must be answered is : when must we operate on a patient when diverticulosis becomes symptomatic without significant complications .
the following characteristics should be present : 2 consecutive attacks of acute diverticulitis ( clinically controlled ) ; adequate time interval between the 2 attacks ( 1 to 2 months ) with appropriate medical - dietetic therapy , but not followed by stable improvement ; age < 60 years .
the immediate postoperative results are to be examined in terms of operative morbidity and mortality and other possible advantages of one approach over another .
the results of the stable correction of the pathology are not in discussion , because the intervention is identical in both procedures , so this result is related to the correctness of the indication .
the immediate results can be evaluated based on the following criteria , and compared with those of the traditional open technique : operative time and index of conversion , resumption of bowel movements and alimentation , ambulation , hospital stay , use of analgesics in the postoperative phase ( postoperative comfort ) , postoperative morbidity ( anastomotic dehiscences , bronchopneumonic infiltrates , infections of the operative wound or of the trocar incisions , thrombo - embolic accidents ) , operative mortality .
we think that , even with a longer operative time in comparison with the conventional approach and the necessity for adequate training in the laparoscopic technique , the best quality of the postoperative course and similar morbidity are evidence favorable to the laparoscopic procedure . at present , the routine indication of laparoscopy for benign colic pathologies is considered correct and effective .
in fact , the advantages of the mini - invasive approach are incontestable , because of less postoperative pain , less parietal trauma , and the disappearance , after a while , of complications like postoperative laparocele .
the resumption of intestinal function with a more precocious return to alimentation surely represents a great advantage , together with the rapid ambulation , a shorter and more comfortable postoperative stay , and a more rapid resumption of social activities . in this analysis
, operative morbidity needs careful evaluation , and it assumes great importance in the treatment of a benign , uncomplicated pathology .
data reported in the literature confirm that the occurrence of anastomotic dehiscences is similar in both the laparoscopic and open procedures .
the remaining elements of postoperative morbidity are the same in the 2 procedures ; moreover , we must consider that the precocious ambulation after laparoscopic procedures allows a sort of protection from both the bronchopneumonic affects and thromboembolic accidents .
the limits of the indication for laparoscopic surgery in the treatment of diverticular disease are the object of investigation at present . in acute ,
uncomplicated diverticulitis , the importance of a correct surgical indication and an adequate selection of the patients to undergo laparoscopic intervention is evident , so the surgical procedure is standardized . in an emergency
, it is still difficult to define unequivocally the criteria for the choice of either the laparoscopic or the open approach to treat the complications of diverticular disease .
the indication for the laparoscopic intervention for complicated diverticulitis is still an argument in evolution . in complicated diverticulitis ( abscess , fistula , generalized peritonitis ) ,
the incidence of conversion is still very high : according to the literature , it should reach 61% versus 14% in acute uncomplicated diverticulitis . probably in the future , the laparoscopic indications will be very widespread even for complicated diverticulitis .
the advantages of the laparoscopic approach in benign colonic pathology are represented by a shorter and more comfortable postoperative period with the minor use of analgesics , more rapid ambulation , and early resumption of alimentation and bowel activity .
this study contributes to the literature by demonstrating the feasibility and safety of the laparoscopic - assisted left colectomy in uncomplicated diverticulitis .
 objectives : the aim of this study was to evaluate the safety and effectiveness of laparoscopic - assisted sigmoid colectomy for diverticulitis and to assess its postoperative advantages.methods:from 1999 to 2001 , 5 patients were selectively operated on with a laparoscopic - assisted procedure for uncomplicated sigmoid diverticulitis . in the preceding period ( september 1997 through december 1998 ) , 
 4 patients underwent open procedures for the same pathology . the surgical indication with the same criteria was restrictive : at least 2 acute episodes had occurred that were treated with hospital admission and that were separated by an adequate period ( 2 months ) of medical therapy.results:no conversions of laparoscopy to an open procedure were necessary . 
 age , sex , weight , morbidity , and mortality were similar between the 2 groups . 
 operative time was 180 minutes for laparoscopy and 120 minutes for laparotomy . 
 postoperative resumption of peristalsis was 24 hours versus 4 days , resumption of alimentation was on the second postoperative day versus the fifth postoperative day , and hospital stay was 7 days versus 12 days for laparoscopy and laparotomy , respectively.conclusion:this study shows the feasibility and the advantages of elective laparoscopic - assisted colonic re - section for uncomplicated sigmoid diverticulitis . 
 the advantages of the laparoscopic approach are the lower need for analgesics and the more precocious ambulation , canalization , resumption of alimentation , and the shorter hospital stay . 
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION