Single-Incision Laparoscopic Surgery (SILS) Assisted Sigma Resection Via Pfannenstiel Incision for Complicated Diverticulitis

Abstract

Arne Dietrich, Gereon Gäbelein, Christoph Benckert, Woubet Kassahun, Sven Jonas

Background: Single-incision laparoscopic surgery (SILS) is frequently used for indications such as appendectomy, cholecystectomy or sigmoid surgery. Usually, an umbilical incision is used as access and for specimen retrieval. However, the umbilical access for SILS is linked with technical limitations in the pelvic area. Here we use a Pfannenstiel incision for SILS sigma or anterior rectum resection for complicated diverticulitis. Methods: An SILS sigma or anterior resection was performed using a Pfannenstiel access to the abdominal cavity. A Gelport (Applied Medical) with three trocars was used. In one patient, an elective resection after initially conservative treatment for a covered perforation was performed, two patients underwent resection due to an abscess and fistula (into the urinary bladder or vagina), and in two patients an early resection was performed due to abdominal abscesses. All patients suffered from sigmoid diverticulitis, which was stage IIb according to Hansen and Stock. Results: The operation time ranged from 89 to 280 min. There were no conversions, and no additional trocars were used. The postoperative hospital stay ranged from 5 to 14 days. All patients were discharged without any intraoperative or postoperative complications. Conclusions: SILS sigma or anterior rectum resection for complicated diverticulitis can be performed via a Pfannenstiel incision. This approach provides direct visualization and access into the pelvis as well as the option to benefit from open surgery devices. The Pfannenstiel incision may generally be recommended for the favorable cosmetic effect and the very low rate of incisional hernias, as reported in the literature