Faster bowel recovery with superior haemorrhoidal artery preservation in patients undergoing sigmoidectomy for diverticular disease: A retrospective cohort study from the diverticular disease registry trial

Abstract Introduction: The pathogenesis of diverticular disease varies significantly and so does its clinical presentation. The procedure for left-sided diverticular disease is standardised, but there is still no consensus on the level of arterial ligation. In 2021, our group initiated the Diverticular Disease Registry (DDR) Trial, a multi-institutional registry on diverticular disease. The aim of this study is to analyse patients enrolled in the DDR who underwent elective laparoscopic sigmoidectomy to determine if different arterial ligations result in differences in bowel function. Patients and Methods: Patients enrolled in the DDR from June 2021 to January 2024 were reviewed. Inclusion criteria included elective sigmoidectomy for diverticular disease, reported pre-operative bowel preparation and availability of data on the level of the arterial section. Patients were grouped according to the level of artery ligation: the superior haemorrhoidal artery transection (SHA-T) group and the superior haemorrhoidal artery preservation (SHA-P) group. Results: A total of 242 patients were enrolled at 8 hospitals. One hundred and ten patients were included in the analysis. Hospital stay was shorter although not significantly in the SHA-P group compared to the SHA-T group (5 ± 2 vs. 6 ± 1.5; P = 0.062). The first flatus occurred earlier in the SHA-P group, approaching the level of significance (1 ± 0.5 vs. 2 ± 0.8; P = 0.057). Bowel function restored significantly earlier in the SHA-P group (2 ± 0.4 vs. 3 ± 2.1; P = 0.041). Conclusions: Our study reported improved bowel function in patients undergoing SHA preservation during elective sigmoidectomy for diverticular disease.