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Laparoscopic lavage and drainage for Hinchey III diverticulitis: review of technical aspects

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Abstract

The surgical treatment for patients with generalized peritonitis complicating sigmoid diverticulitis is currently debated; particularly in case of diffuse purulent contamination (Hinchey 3). Laparoscopic lavage and drainage (LLD) has been proposed by some authors as a safe and effective alternative to single- or multi-stage resective surgery. However, among all the different studies on LLD, there is no uniformity in terms of surgical technique adopted and data show significant differences in postoperative outcomes. Aim of this review was to analyze the differences and similarities among the authors in terms of application, surgical technique and outcomes of LLD in Hinchey 3 patients. A bibliographical research was performed by referring to PubMed and Cochrane. “Purulent peritonitis”, “Hinchey 3 diverticulitis”, “acute diverticulitis”, “colonic perforation” and “complicated diverticulitis” were used as key words. Twenty-eight papers were selected, excluding meta-analysis, reviews and case reports with a very small number of patients. The aim of this review was to establish how LLD should be done, suggesting important technical tricks. We found agreement in terms of indications, preoperative management, ports’ positioning, antibiotics, enteral feeding and drain management. On the contrast, different statements regarding indications, adhesiolysis and management of colonic hole and failure of laparoscopic lavage are reported. A widespread diffusion of LLD and standardization of its technique are impossible because of data heterogeneity and selection bias in the limited RCTs. It is necessary to wait for long terms results from randomized clinical trials (RCTs) in progress to establish the efficacy and safety of this technique. More importantly, an increased number of highly skilled and dedicated colorectal laparoscopic surgeons are required to standardized the procedure.

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Author information

Authors and Affiliations

  1. University Hospitals Birmingham, “Queen Elizabeth Hospital” Birmingham, Birmingham, UK

    Matteo Gregori

  2. Department of Mini-invasive and Robotic Surgery, Abano Terme, Padua, Italy

    Diletta Cassini, Farshad Manoochehri & Gianandrea A. Baldazzi

  3. First Department of Surgery “Pietro Valdoni”, “Sapienza” Medical School, Rome, Italy

    Norma Depalma & Michelangelo Miccini

  4. 3 New Street Chambers, 67A New Street, Birmingham, B2 4DU, UK

    Matteo Gregori

Authors
  1. Matteo Gregori
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  6. Gianandrea A. Baldazzi
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Correspondence to Matteo Gregori.

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We have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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All procedure performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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An informed consent was obtained from the patient involved in the study.

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The article is part of topical collection on mini-invasive colorectal surgery.

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Gregori, M., Cassini, D., Depalma, N. et al. Laparoscopic lavage and drainage for Hinchey III diverticulitis: review of technical aspects. Updates Surg 71, 237–246 (2019). https://doi.org/10.1007/s13304-018-0576-7

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  • DOI: https://doi.org/10.1007/s13304-018-0576-7

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