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Laparoscopic Two-Stage Left Colonic Resection for Patients with Peritonitis Caused by Acute Diverticulitis

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Diseases of the Colon & Rectum

Purpose

Purulent or fecal peritonitis is one of the most serious complications of acute diverticulitis. Up to one-fourth of patients hospitalized for acute diverticulitis require an emergent operation for a complication, including abscess, peritonitis, or stenosis. Open Hartmann’s procedure has been the operation of choice for these patients. The advantages of laparoscopy could be combined with those of the primary resection in selected patients with peritonitis complicating acute diverticulitis. However, because of technical difficulties and the theoretic risk of poorly controlled sepsis, laparoscopic Hartmann’s procedure has been seldom reported for such patients.

Methods

Data were prospectively collected from 2003 to 2005 in a single referral center specialized in abdominal emergencies. Laparoscopic Hartmann’s procedure (Stage 1) was performed in selected patients with peritonitis complicating acute diverticulitis. Secondarily, Hartmann’s reversal (Stage 2) also was performed laparoscopically.

Results

Thirty-one patients were studied. The median Mannheim Peritonitis Index score was 21 (±5; range, 12–32). The conversion rate was 19 and 11 percent for Stage 1 and Stage 2, respectively. There was no perioperative uncontrolled sepsis. Overall operative 30-day mortality and morbidity rates were 3 and 23 percent for Stage 1, and 0 and 15 percent for Stage 2, respectively. Stoma reversal was possible in 90 percent of patients.

Conclusions

The results of this small series demonstrated that the indications of laparoscopy in diverticulitis could be extrapolated to selected patients with peritonitis. The technical feasibility and safety of laparoscopic Hartmann’s procedure in selected patients seem acceptable. However, larger-scale, controlled studies are needed to define more accurately the role of laparoscopy in complicated diverticulitis.

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Authors and Affiliations

  1. Department of General and Minimally Invasive Surgery, Centre Hospitalier Intercommunal, 10, rue du Champ Gaillard, Poissy, 78300, France

    Elie Chouillard M.D., Léon Maggiori M.D., Toufic Ata M.D., Slim Jarbaoui M.D., Emmanuel Rivkine M.D., Léonor Benhaim M.D., Eva Ghiles M.D., Jean-Charles Etienne M.D. & Abe Fingerhut M.D., F.R.C.S.

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  1. Elie Chouillard M.D.
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  2. Léon Maggiori M.D.
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  3. Toufic Ata M.D.
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Correspondence to Elie Chouillard M.D..

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Chouillard, E., Maggiori, L., Ata, T. et al. Laparoscopic Two-Stage Left Colonic Resection for Patients with Peritonitis Caused by Acute Diverticulitis. Dis Colon Rectum 50, 1157–1163 (2007). https://doi.org/10.1007/s10350-006-0851-4

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