Funktionelle Ergebnisse nach laparoskopischer vs. roboterassistierter Sigmaresektion bei Divertikulitis

Zusammenfassung

Hintergrund Die Sigmaresektion bei Divertikulitis zählt zu den am häufigsten durchgeführten Kolonresektionen. Die minimalinvasive laparoskopische Resektion stellt dabei den operativen Goldstandard dar. Seit wenigen Jahren werden Sigmaresektionen auch roboterassistiert (Da-Vinci^®-System) durchgeführt. Unklar ist, ob in Bezug auf das funktionelle Outcome relevante Unterschiede zwischen beiden Verfahren bestehen.

Material und Methoden Es erfolgte eine postoperative Nachbefragung aller Patienten, bei denen im Zeitraum November 2013 bis November 2018 eine laparoskopische oder roboterassistierte Sigmaresektion bei Divertikulitis durchgeführt wurde, mit einem Mindestabstand von 6 Monaten zur Operation. Es wurden Kontinenzstörungen, die Entwicklung der Beschwerden gegenüber dem präoperativen Zustand, Veränderungen des Stuhlgangs (Obstipation, Diarrhö), Beeinträchtigung im Alltag und Schmerzen erfasst. Unterschiede zwischen den Gruppen wurden anhand des Chi-Quadrat-Tests auf statistische Signifikanzen geprüft.

Ergebnisse Im Untersuchungszeitraum wurden insgesamt 106 minimalinvasive Sigmaresektionen bei Divertikulitis durchgeführt (laparoskopisch: n = 46, roboterassistiert: n = 60). Davon beantworteten 74 Patienten (70%; laparoskopisch: n = 28, roboterassistiert: n = 46) den Fragebogen und wurden in die Auswertung aufgenommen. Kontinenzstörungen wurden in insgesamt 22% der Fälle angegeben. In keiner der abgefragten Variablen ergab sich zwischen den Gruppen ein statistisch signifikanter Unterschied.

Schlussfolgerung In Bezug auf funktionelle Ergebnisse nach minimalinvasiver Sigmaresektion bei Divertikulitis sind die laparoskopische und die roboterassistierte Sigmaresektion als gleichwertige Verfahren anzusehen.

Abstract

Background Sigmoid resection in diverticulitis is one of the most frequently performed colonic operations. A minimally invasive approach by laparoscopy is the surgical gold standard. For a few years now, sigmoid resections have also been performed robotically (da Vinci^® System). It is unclear whether there are relevant differences between the two procedures in terms of functional outcome.

Methods A postoperative follow-up was performed on all patients who underwent laparoscopic or robotic sigmoid resection for diverticulitis between November 2013 and November 2018, with a minimum interval of 6 months between surgery. Continence disorders, the development of symptoms compared to preoperative, changes in bowel movement (constipation, diarrhoea), impairment in daily life and pain were recorded. Differences between the groups were checked for statistical significance using the chi-square test.

Results During the study period, a total of 106 minimally invasive sigmoid resections for diverticulitis were performed (laparoscopic: n = 46, robot-assisted: n = 60). Of these, 74 patients (70%; laparoscopic: n = 28, robot-assisted: n = 46) answered the questionnaire and were included in the evaluation. Continence disorders were reported in a total of 22% of cases. There was no statistically significant difference between the groups in any of the variables surveyed.

Conclusion With regard to functional results after minimally invasive sigmoid resection for diverticulitis, laparoscopic and robot-assisted sigmoid resection can be considered equivalent procedures.

Schlüsselwörter

Divertikulitis - roboterassistierte Chirurgie - funktionelle Ergebnisse - Sigmaresektion

Key words

diverticular disease - robot-assisted surgery - functional outcome - sigmoid resection

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