Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis

Background: This prospective study evaluated the technical aspects and microbiological consequences of laparoscopic resection with transanal specimen extraction and per ano transcolonic stapler anvil insertion in patients requiring elective operation for previous diverticulitis. Methods: Laparoscopic sigmoid colectomy was performed with three ports, and specimen extraction carried out transanally through a complete opening of the rectal stump. A triple-stapled anastomosis restored colonic continuity. Systematic intraoperative bacteriological sampling was performed. Intraoperative data as well as microbiological and postoperative outcomes were evaluated prospectively. Results: Sixteen consecutive patients were studied over a 6-month period. All procedures were technically satisfactory, with a mean(s.d.) operating time of 120.9(41.9) min. No conversion or additional access was required. Four of the 16 patients developed complications, but none required intervention. Although polybacterial growth was present in all peritoneal culture samples, no infection-related complications were observed. Two patients had an extended course of perioperative antibiotic cover owing to overt peritoneal cavity contamination during surgery, and in two further patients antibiotics were instituted empirically following the development of postoperative fever alone. Conclusion: Transanal specimen extraction in addition to per ano transcolonic stapler anvil insertion allows laparoscopic sigmoid resection to be performed with just three ports. Although intraperitoneal bacterial contamination occurs, this does not appear to translate into infectious morbidity.