IMPACT OF ELECTIVE LAPAROSCOPIC SIGMOID RESECTION ON QUALITY OF LIFE IN
SIGMOID DIVERTICULITIS
Principal Author: Jorge Silva, MD1
Co-authors: Luca Stocchi, MD2, Gokhan Ozuner, MD2
1
Reasearch Fellow, Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio.
2
Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio.
Purpose: A number of reports have suggested that surgery for sigmoid diverticulitis is frequently ineffective at
improving quality of life (QoL). The aim of this study was to assess changes in QoL following laparoscopic
sigmoidectomy and evaluate possible factors associated with such QoL changes.
Methods: Patients undergoing elective laparoscopic restorative resection for CT-proven sigmoid diverticulitis
between 2000-2012 who answered SF-36 surveys both preoperatively and at least 3 months postoperatively were
identified from a prospectively maintained database. Preoperative and postoperative mental and physical component
summary (MCS/PCS) scores, including eight individual SF-36 domains (Vitality, Social Functioning, RoleEmotional, Mental Health for MCS, and Physical Functioning, Role-Physical, Bodily Pain, General Health for PCS)
were compared. A number of factors were assessed for possible association with QoL including demographics,
comorbidities, previous diverticulitis episodes, clinical presentation, radiological findings, individual surgeon,
surgical and pathological findings, and postoperative morbidity.
Results: Out of 370 patients who were offered QoL questionnaires at the time of elective laparoscopic resection,
282 provided QoL data and 56 fulfilled the inclusion criteria, of whom 38 (68%) had increased postoperative MCS
scores whereas 42 (75%) had increased postoperative PCS scores. Both overall MCS and PCS scores significantly
increased after surgery (p = 0.001 and p <0.001, respectively). Specifically, all SF-36 individual domain scores
except physical functioning and role-emotional significantly increased postoperatively when compared to
preoperative scores (Table). Preoperative lower gastrointestinal bleeding was significantly associated with lack of
improvement in PCS scores (p=0.012).
Conclusions: Elective laparoscopic restorative sigmoidectomy for sigmoid diverticulitis is generally effective in
improving patient QoL. Patients with gastrointestinal bleeding as one of their presenting symptoms should be
advised of its negative effect on QoL.
Table. Comparison of Preoperative and Postoperative SF-36 Component and
Domain Scores*
SF-36
Components and
Domains
Mean±SD
Preoperative
Score
47.39 ± 10.74
Postoperative
Score
51.60 ± 10.08
Role-emotional
-0.33 ± 1.22
0.06 ± 1.01
0.07
Vitality
-0.16 ± 1.13
0.20 ± 1.06
0.006
Social function
-0.59 ± 1.22
0.04 ± 0.88
<0.001
Mental health
-0.23 ± 1.19
0.10 ± 1.02
0.002
46.33 ± 8.65
50.37 ± 8.68
<0.001
Physical function
-0.08 ± 1.06
0.00 ± 1.15
0.07
Role-physical
-0.54 ± 1.23
0.06 ± 0.99
0.002
Bodily pain
-0.72 ± 1.06
0.14 ± 0.94
<0.001
General health
-0.02 ± 1.02
0.18 ± 0.93
0.002
MCS
PCS
p Value
0.001
Abbreviations: SF-36, Short Form 36; SD, standard deviation; MCS, Mental Component Summary; PCS,
Physical Component Summary
* Domain scores are presented as Z scores, with the general population having 0 ± 1; increases in postoperative
scores reflect increases in QoL