Analysis of the Effectiveness of Minimally Invasive Surgical Interventions in Chronic Complicated Forms of Colonic Diverticulitis

Introduction. Diverticular disease refers to common non-neoplastic diseases of the colon, accounting for 30–60% of all pathologies of the organ. According to clinical guidelines, the treatment strategy for complicated forms of diverticulitis is predominantly conservative. However, certain forms of chronic complicated diverticulitis require surgical intervention, particularly sigmoid resection.

Materials and methods. The study involved a retrospective analysis of robot-assisted, laparoscopic, and open sigmoid resections for chronic complicated forms of diverticular disease of the colon. From 2014 to 2023, a total of 85 patients underwent surgery at the Clinic of Bashkir State Medical University. In Group 1, 24 patients (28.3%) underwent surgery, in Group 2 — 28 patients (32.9%), and in Group 3 — 33 (38.8%). The results were processed using mathematical statistical methods, MS Excel XP, and Statistica 10.0 software.

Results and discussion. The comparative analysis of minimally invasive surgical interventions and open surgeries revealed that the application of minimally invasive surgery, specifically robot-assisted and laparoscopic approaches, is associated with reduced hospital stay and fewer postoperative complications compared to similar metrics observed with open surgical procedures.

Conclusion. The study findings indicate the advantages of robot-assisted surgeries in certain cases, which, as an alternative method, do not fall short of traditional laparoscopic surgical techniques. Moreover, robot-assisted interventions are associated with earlier postoperative recovery and reduced hospital stay.

1. Ardatskaya M.D., Achkasov S.I., Veselov V.V., Zarodnyuk I.V., Ivashkin V.T., Karpukhin O.Yu., Kashnikov V.N., et al. Diverticular disease. Koloproktologia. 2021;20(3):10–27 (In Russ.). DOI: 10.33878/2073-7556-2021-20-3-10-27

2. Svistunov A.A., Osadchuk M.A., Kireeva N.V., Zolotovitskaya A.M. Diverticular disease of the colon. Klin. med. 2018;96(6):498–505 (In Russ.). DOI: 10.18821/0023-2149-2018-96-6-498-505

3. Barroso A.O., Quigley E.M. Diverticula and Diverticulitis: Time for a Reappraisal. Gastroenterol Hepatol (N Y). 2015;11(10):680–8. PMID: 27330495

4. Aliyev S.A., Aliyev E.S., Gahramanova F.A. Discussion aspects of treatment for diverticular disease complicated with first episode of acute diverticulitis. Koloproktologia. 2020;19(2):53–59 (In Russ.). DOI: 10.33878/2073-7556-2020-19-2-53-59

5. Ivashkin V.T., Shelygin Yu.A., Achkasov S.I., Vasilyev S.V., Grigoryev Ye.G., Dudka V.V., et al. Diagnostics and treatment of diverticular disease of the colon: guidelines of the Russian gastroenterological Association and Russian Association of Coloproctology. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2016;26(1):65–80 (In Russ.). DOI: 10.22416/1382-4376-2016-26-1-65-80

6. Giuliani G., Guerra F., Coletta D., Giuliani A., Salvischiani L., Tribuzi A., et al. Robotic versus conventional laparoscopic technique for the treatment of left-sided colonic diverticular disease: a systematic review with meta-analysis. Int J Colorectal Dis. 2022;37(1):101–9. DOI: 10.1007/s00384-021-04038-x

7. Solaini L., Bocchino A., Avanzolini A., Annunziata D., Cavaliere D., Ercolani G. Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis. Int J Colorectal Dis. 2022;37(7):1497–507. DOI: 10.1007/s00384-022-04194-8

8. Raskin E.R., Keller D.S., Gorrepati M.L., Akiel-Fu S., Mehendale S., Cleary R.K. Propensity-matched analysis of sigmoidectomies for diverticular disease. JSLS. 2019;23(1):e2018.00073. DOI: 10.4293/JSLS.2018.00073

9. Haas J.M., Singh M., Vakil N. Mortality and complications following surgery for diverticulitis: Systematic review and meta-analysis. United European Gastroenterol J. 2016;4(5):706–13. DOI: 10.1177/2050640615617357

10. Bedzhanyan A.L., Sumbaev A.A., Petrenko K.N., Frolova Yu.V., Temirsultanova Kh.R., Goncharov A.L., et al. Immediate results of robot-assisted and laparoscopic interventions in sigmoid and rectal cancer surgery. Clinical and Experimental Surgery. Petrovsky Journal. 2022;10(2):103–11 (In Russ.). DOI: 10.33029/2308-1198-2022-10-2-103-111

11. Haas J.M., Singh M., Vakil N. Mortality and complications following surgery for diverticulitis: Systematic review and meta-analysis. United European Gastroenterol J. 2016;4(5):706–13. DOI: 10.1177/2050640615617357

12. Royds J., O’Riordan J.M., Eguare E., O’Riordan D., Neary P.C. Laparoscopic surgery for complicated diverticular disease: a single-centre experience. Colorectal Dis. 2012;14(10):1248–54. DOI: 10.1111/j.1463-1318.2011.02924.x

13. Klarenbeek B.R., Veenhof A.A., Bergamaschi R., van der Peet D.L., van den Broek W.T., de Lange E.S., et al. Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma Trial. Ann Surg. 2009;249(1):39–44. DOI: 10.1097/SLA.0b013e31818e416a

14. Hassan I., Cima R.R., Larson D.W., Dozois E.J., O’Byrne M.M., Larson D.R., et al. The impact of uncomplicated and complicated diverticulitis on laparoscopic surgery conversion rates and patient outcomes. Surg Endosc. 2007;21(10):1690–4. DOI: 10.1007/s00464-007-9413-7

15. Weber P.A., Merola S., Wasielewski A., Ballantyne G.H. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum. 2002;45(12):1689–94; discussion 1695–6. DOI: 10.1007/s10350-004-7261-2

16. Andolfi C., Umanskiy K. Appraisal and current considerations of robotics in colon and rectal surgery. J Laparoendosc Adv Surg Tech A. 2019;29(2):152–8. DOI: 10.1089/lap.2018.0571

17. Antoniou S.A., Antoniou G.A., Koch O.O., Pointner R., Granderath F.A. Robot-assisted laparoscopic surgery of the colon and rectum. Surg Endosc. 2012;26(1):1–11. DOI: 10.1007/s00464-011-1867-y

18. Miller P.E., Dao H., Paluvoi N., Bailey M., Margolin D., Shah N., et al. Comparison of 30-day postoperative outcomes after laparoscopic vs robotic colectomy. J Am Coll Surg. 2016;223(2):369–73. DOI: 10.1016/j.jamcollsurg.2016.03.041

19. Chang Y.S., Wang J.X., Chang D.W. A meta-analysis of robotic versus laparoscopic colectomy. J Surg Res. 2015;195(2):465–74. DOI: 10.1016/j.jss.2015.01.026

20. Mushtaq H.H., Shah S.K., Agarwal A.K. The current role of robotics in colorectal surgery. Curr Gastroenterol Rep. 2019;21(3):11. DOI: 10.1007/s11894-019-0676-7

21. Giordano L., Kassir A.A., Gamagami R.A., Lujan H.J., Plasencia G., Santiago C. Robotic-assisted and laparoscopic sigmoid resection. JSLS. 2020;24(3):e2020.00028. DOI: 10.4293/JSLS.2020.00028