EP706 - Open versus Minimally Invasive Elective Colectomy with Splenic Flexure Mobilization for Diverticulitis: National Outcomes from a Propensity-Matched Analysis

ePoster Presenter(s)

• HH

  HyukJoo Hwang

  Medical Student
  University of Massachusetts Chan Medical School
  University of Massachusetts Chan Medical School
  Worcester, MA, United States

  Disclosure information not submitted.

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Author(s)

• 

  Benjamin Gallant, MD

  General Surgery Resident
  UMass Chan Medical School
  UMass Chan Medical School
  Worcester, MA, United States

  Disclosure information not submitted.
• 

  Andrew Hu, MD

  General Surgery Resident
  UMass Chan Medical School
  University of Massachusetts T.H Chan Medical School
  Worcester, MA, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• 

  Carlos Fairen Oro, Fellow (he/him/his)

  Colon and Rectal Surgery Fellow
  UMass Chan Medical School
  UMass Chan Medical School
  Worcester, MA, United States

  Disclosure information not submitted.
• TP

  Thomas Peponis, MD, FACS

  Colon and Rectal Surgeon, Assistant Professor of Surgery
  University of Massachusetts
  Worcester, Massachusetts, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• 

  Tess H. Aulet, MD (she/her/hers)

  Colorectal Surgeon
  UMass Memorial Medical Center
  UMass Memorial Medical Center
  Worcester, Massachusetts, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
• PS

  Paul R. Sturrock, MD

  Assistant Professor of Surgery
  UMassMemorial Medical Center
  Worcester, Massachusetts, United States

  Disclosure information not submitted.
• 

  Justin Maykel, MD

  Chief, Division of Colorectal Surgery
  UMass Memorial Health
  UMass Chan Medical School
  Worcester, MA, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

Senior Author(s)

• 

  Karim Alavi, MD, MPH

  Associate Professor of Surgery, Director, Colon and Rectal Surgery Fellowship
  UMass Chan Medical School
  southborough, Massachusetts, United States

  Disclosure information not submitted.

Purpose/Background: Splenic flexure mobilization may be necessary to achieve a tension-free anastomosis in patients undergoing elective sigmoidectomy for diverticulitis. Comparative outcomes between open and minimally invasive approaches (MIS) remain poorly defined. This study aimed to evaluate the short-term outcomes of open versus MIS splenic flexure mobilization during elective segmental colectomy for diverticulitis.

Methods/Interventions: We queried the TriNetX Research Network to identify adult patients undergoing open or minimally invasive elective colectomy for diverticulitis with splenic flexure mobilization. TriNetX is a global health research network that queries and aggregates de-identified patient data from electronic health records, constantly updating the dataset to offer more current and accurate insights for research feasibility and analysis. Patient records used in this study included up to 20 years of longitudinal data and were current as of October 2025. Patients were stratified by operative approach: open versus MIS (laparoscopic or robotic). Propensity score matching was performed to balance demographics and comorbidities. The study's primary outcome was length of stay (LOS), and 30-day adverse events were analyzed as secondary outcomes.

Results/Outcomes: A total of 10,581 patients were identified. 3,055 patients underwent open, and 7,526 patients underwent MIS splenic flexure mobilization and segmental colectomy. After propensity score matching, 5,428 were identified, including 2,714 undergoing open and 2,714 undergoing MIS splenic flexure mobilization. At three days, patients in the open group were 14% less likely to be discharged (RR 0.86, 95% CI: 0.83-0.89). At 30 days, patients in the open group were more likely to require blood transfusions postoperatively (RR 1.98, 95% CI: 1.42-2.76). Postoperatively, the open cohort was more likely to experience sepsis (RR 2.73, 95% CI: 2.07-3.6), surgical wound dehiscence (RR 4.7, 95% CI: 3-7.34), acute renal failure (RR 1.86, 95% CI: 1.57-2.24), and ventilator dependence (RR 4.17, 95% CI: 2.66-6.56) at 30 days.

Conclusion/Discussion: Our findings suggest that sigmoid colectomy with splenic flexure mobilization performed in a minimally invasive fashion is associated with significantly shorter LOS and postoperative morbidity compared to an open approach. A substantial number of patients with diverticulitis still undergo open surgery in elective settings. To improve patient outcomes following surgery for diverticulitis, there needs to be an accelerated focus on increasing the adoption of MIS techniques, particularly as open splenic mobilization remains a common practice.

Table 1. Post-matching Demographics
Table 2. Risk of Postoperative Outcomes Following Open Surgical Approach