Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a definitive treatment? Retrospective analysis of 63 cases

• Published in: Techniques in coloproctology 2015-02, Vol.19 (2), p.105-110
• Main Authors: Sorrentino, M., Brizzolari, M., Scarpa, E., Malisan, D., Bruschi, F., Bertozzi, S., Bernardi, S., Petri, R.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Colorectal Surgery; Diverticulitis, Colonic - complications; Diverticulitis, Colonic - therapy; Female; Gastroenterology; Humans; Intestinal Perforation - complications; Intestinal Perforation - therapy; Laparoscopy - statistics & numerical data; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Operative Time; Original Article; Peritoneal Lavage - methods; Peritonitis - etiology; Peritonitis - surgery; Proctology; Recurrence; Retrospective Studies; Surgery; Treatment Outcome
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-014-1258-1

Background The ideal treatment of perforated diverticulitis and the indications for elective colon resection remain controversial. Considering the significant morbidity and mortality rates related to traditional resection, efforts have been made to reduce the invasiveness of surgery in recent decades. Laparoscopic peritoneal lavage has emerged as an effective alternative option. We retrospectively investigated the effectiveness of laparoscopic peritoneal lavage for perforated diverticulitis and the possibility that it could be a definitive treatment. Methods We included patients treated with laparoscopic peritoneal lavage for perforated diverticulitis. The inclusion criteria were all emergency patients with generalized peritonitis due to Hinchey III perforated diverticulitis and some cases of Hinchey II and IV. Results Sixty-three patients were treated with laparoscopic peritoneal lavage. Six patients (9.5 %) had Hinchey II diverticulitis; 54 patients (85.7 %) had Hinchey III; and three patients (4.8 %) had Hinchey IV. The mean operative time was 87.3 min (±25.4 min), and the overall morbidity rate was 14.3 %. One patient died because of pulmonary embolism, and there were six early reinterventions because of treatment failure. Delayed colon resection was performed in four of the remaining 57 patients (7 %) because of recurrent diverticulitis. In the other 53 patients (93 %), we saw no recurrence of diverticulitis and no intervention was performed after a median follow-up period of 54 months (interquartile range 27–98 months). Conclusions Laparoscopic peritoneal lavage for perforated diverticulitis can be considered a safe and effective alternative to traditional surgical resection, and using this approach, most elective colon resection might be avoided.