Is postoperative morbidity following laparoscopic sigmoid colectomy for diverticulitis avoidable?

Silva-Velazco and coworkers from the Department of Colorectal Surgery at Cleveland Clinic Foundation assessed 1,059 patient who underwent laparoscopic sigmoid colectomy for diverticulitis between 1992 and 2013. They identified a 13.1% conversion rate, an overall morbidity rate of 28%, and anastomotic leak rate of 3.7%. In-depth statistical evaluation identified several risk factors associated with morbidity including BMI ≥ 35, complicated diverticulitis, and “rectal transection with a traditional linear stapler”. Based upon the authors’ findings the only potentially modifiable risk factor would be the method of rectal transection. BMI is substantially modifiable and the complexity of the diverticulitis may also be difficult to modify in a reasonable time frame. One of the potential limitations of the study is the fact that the data were collected over the period of two decades; undoubtedly the technique and in fact the surgeons performing the procedures substantially changed during this time period. However, the risk factors of increased BMI and increased complexity of diverticulitis are easily understood as risk factors for postoperative morbidity. Significant attention has recently been paid to the method of distal rectal transection including the number of stapler firings. Ideally awareness of these risk factors and modification of them where possible will help us try to optimize patient outcomes.