Laparoscopic peritoneal lavage versus laparoscopic sigmoidectomy in complicated acute diverticulitis: a multicenter prospective observational study
Laparoscopic peritoneal lavage (LPL) is feasible in selected patients with pelvic abscess and generalized purulent peritonitis caused by acute diverticulitis. We aimed to compare LPL and laparoscopic sigmoidectomy (LS) in complicated acute diverticulitis.
This prospective, observational, multicenter study included patients with a pelvic abscess not amenable to conservative management and patients with Hinchey III acute diverticulitis, from 2015 to 2018. Sixty-six patients were enrolled: 28 (42%) underwent LPL and 38 (58%) underwent LS. In LS, patients had a primary anastomosis, with or without ileostomy, or an end colostomy (HA). Major outcomes were mortality, morbidity, failure of source control, reoperation, length of stay, and diverticulitis recurrence.
Patient demographics were similar in the two groups. In LPL, ASA score > 2 and Mannheim Peritonitis Index were significantly higher (p = 0.05 and 0.004). In LS, 24 patients (63%) had a PA and 14 (37%) an HA. No death was recorded. Overall, morbidity was 33% in LPL and 18% in LS (p = 0.169). However, failure to achieve source control of the peritoneal infection and the need to return to the operating room were more frequent in LPL (p = 0.002 and p = 0.006). Mean postoperative length of stay was comparable (p = 0.08). Diverticular recurrence was significantly higher in LPL (p = 0.003).
LPL is related to a higher reoperation rate, more frequent postoperative ongoing sepsis, and higher recurrence rates. Therefore, laparoscopic lavage for perforated diverticulitis carries a high risk of failure in daily practice.
KeywordsComplicated acute diverticulitis Laparoscopic lavage Laparoscopic sigmoidectomy Resection–anastomosis Hartmann’s procedure
The authors would like to thank Dr. Johannes Kurt Schultz from the Arkhensus University Hospital in Oslo, Norway, for his valuable critical revision and comments.
Study conception and design: Tartaglia, Chiarugi.
Data acquisition: Tartaglia, Di Saverio, Stupalkowska, Giannessi, Robustelli, Coccolini, Ioannidis, Nita, Durán Muñoz-Cruzado, Pareja Ciuró.
Data analysis and interpretation: Tartaglia, Chiarugi.
Manuscript drafting: Tartaglia.
Critical revision: Chiarugi.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest. The present study has been presented as oral communication at the American College of Surgeons 105th Annual Clinical Congress, Scientific Forum, San Francisco (CA), United States of America
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Comitato Etico di Area Vasta Nord Ovest, CEAVNO, prot. N 890/2015) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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