Supplementary Material for: Emergency Laparoscopic Sigmoidectomy for Perforated Diverticulitis with Generalised Peritonitis: A Systematic Review

Background: Laparoscopic sigmoidectomy for diverticulitis has initially been confined to the elective setting. However, open acute sigmoidectomy for perforated diverticulitis is associated with high morbidity rates that might be reduced after laparoscopic surgery. The aim of this systematic review was to assess the feasibility of emergency laparoscopic sigmoidectomy for perforated diverticulitis. Methods: We performed a systematic search of PubMed, EMBASE and CENTRAL. All studies reporting on patients with perforated diverticulitis (Hinchey III-IV) treated by laparoscopic sigmoidectomy in the acute phase were included, regardless of design. Results: We included 4 case series and one cohort study (total of 104 patients) out of 1,706 references. Hartmann's procedure (HP) was performed in 84 patients and primary anastomosis in 20. The mean operating time varied between 115 and 200 min. The conversion rate varied from 0 to 19%. The mean length of hospital stay ranged between 6 and 16 days. Surgical re-intervention was necessary in 2 patients. In 20 patients operated upon without defunctioning ileostomy, no anastomotic leakage was reported. Three patients died during the postoperative period. Stoma reversal after HP was performed in 60 out of 79 evaluable patients (76%). Conclusions: Acute laparoscopic sigmoidectomy for the treatment of perforated diverticulitis is feasible in selected patients provided they are handled by experienced hands.

背景：乙状结肠镜下乙状结肠切除术最初仅限于选择性治疗。然而，对于穿孔性结肠憩室炎的开放性急性乙状结肠切除术与高发病率相关，而这种发病率在腹腔镜手术后可能会降低。本系统性综述旨在评估急诊腹腔镜下乙状结肠切除术在穿孔性结肠憩室炎治疗中的可行性。方法：我们对PubMed、EMBASE和CENTRAL进行了系统性检索。纳入了所有报道急性期经腹腔镜下乙状结肠切除术治疗的穿孔性结肠憩室炎（Hinchey III-IV级）患者的研究，无论其设计如何。结果：从1,706篇参考文献中，我们纳入了4个病例系列研究和1项队列研究（共104例患者）。在84名患者中进行了Hartmann手术（HP），在20名患者中进行了原位吻合术。平均手术时间在115至200分钟之间。转化率在0至19%之间。平均住院时间在6至16天之间。2名患者需要再次手术。在未进行造口转流术的20名患者中，未报告吻合口漏。术后期间有3名患者死亡。在79名可评估的患者中，60名（76%）进行了HP后的造口逆转。结论：对于经验丰富的手术者，对特定患者进行急性腹腔镜下乙状结肠切除术治疗穿孔性结肠憩室炎是可行的。