Time Trends in Emergency Sigmoidectomy for perforated Diverticulitis: A Single-Center Evaluation

Background: Optimal surgical treatment for complicated sigmoid diverticulitis remains a subject of considerable debate, especially in the era of laparoscopy. Objectives: This study evaluated changes over time in emergency sigmoidectomy for perforated diverticulitis, including the period following the implementation of laparoscopy in a large community teaching hospital. Design: Retrospective chart review. Setting: Single-center study. Patients and Methods: All patients who underwent emergency sigmoidectomy for perforated sigmoid diverticulitis between 2007 and 2018 were retrospectively analyzed. Main Outcome Measure: Postoperative morbidity and mortality. Sample Size: A total of 104 patients (male: female, 58:46; median age, 62.7 years; median body mass index, 27.15 kg/m²) underwent emergency sigmoidectomy. Results: The overall mortality rate was 5%, the complication rate was 66%, and the median length of stay was 11 days. A significant increase in laparoscopic sigmoidectomy procedures was observed, resulting in 94.3% intended laparoscopic procedures from 2015 onward, compared with 0% in 2007–2010 and 50.0% in 2011–2014 ( P < 0.001). Over time, a significant decrease was observed in postoperative morbidity ( P = 0.018), surgical site infections ( P = 0.002), and length of stay ( P < 0.001). Laparoscopic surgery was also associated with significantly fewer surgical site infections ( P = 0,006) and a significantly shorter length of stay ( P < 0.001) compared with open surgery. Conclusion: Laparoscopic sigmoidectomy has become our primary surgical treatment for patients with perforated sigmoid diverticulitis requiring operative intervention. This study demonstrates a significant reduction in morbidity and length of stay over time, with a clear benefit of laparoscopic surgery compared with open surgery. Limitations: The retrospective observational character of the study. Single-center study. Conflicts of interest: There are no conflicts of interest.