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Minimally Invasive Management of Complicated Sigmoid Diverticulitis in the Emergency Setting: Patient Selection, Prerequisite Skills, and Operative Strategies

  • Ron G. Landmann
  • Todd D. FranconeEmail author
Chapter

Abstract

Management of complicated sigmoid diverticulitis with purulent peritonitis (Hinchey III) disease is complex and mandates an individualized multidisciplinary approach, with a high level of surgical expertise and sound clinical judgment. When feasible, percutaneous drainage of drainable abscesses is recommended and may allow deferring surgical intervention. Several surgical approaches have been advocated including Hartmann’s procedure and sigmoid resection and primary colorectal anastomosis with or without fecal diversion. Most recently, the role of laparoscopic peritoneal lavage has been intensely investigated as an organ-preserving alternative. Current published data and clinical guidelines suggest the superiority of sigmoid resection with colorectal anastomosis and diverting loop ileostomy in patients otherwise stable for an operation. Hartmann’s procedure remains a viable and safe alternative in patients hemodynamically unstable or unfit for primary anastomosis. When possible, a minimally invasive approach should be considered given demonstrable benefits in these patients.

Keywords

Complicated diverticulitis Laparoscopic lavage Hartmann’s procedure Minimally invasive surgery 

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Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2020

Authors and Affiliations

  1. 1.Section of Colon and Rectal Surgery, Department of Surgical OncologyInflammatory Bowel Disease Center, Baptist-MD Anderson Cancer CenterJacksonvilleUSA
  2. 2.Newton/Wellesley HospitalNewtonUSA
  3. 3.Massachusetts General HospitalBostonUSA
  4. 4.Tufts Medical UniversityBostonUSA

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