Laparoscopic management of generalized peritonitis due to perforated colonic diverticula

doi:10.1016/S0002-9610(97)89625-0

The American Journal of Surgery

Volume 171, Issue 4, April 1996, Pages 432-434

https://doi.org/10.1016/S0002-9610(97)89625-0 Get rights and content

Purpose

The use of laparoscopic peritoneal lavage in conjunction with parenteral fluids and antibiotic therapy in the management of generalized peritonitis secondary to perforated diverticular disease of the colon was assessed.

Patients and Methods

This cohort comprised 8 patients with generalized peritonitis secondary to perforated diverticular disease of the left colon that was diagnosed laparoscopically. All the patients had purulent peritonitis, but no fecal contamination. They were treated with laparoscopic peritoneal lavage and intravenous fluids and antibiotics.

Results

All patients made a complete recovery, with resumption of normal diet within 5 to 8 days. No patient has required surgical intervention during a 12- to 48-month follow-up. This approach merits further assessment as an alternative to the traditional open surgical management.

References (9)

PeoplesJB et al.
Reassessment of primary resection of the perforated segment for severe colonic diverticulitis
Am J Surg
(1990)
GreggR
An ideal operation for diverticulitis of the colon
Am J Surg
(1987)
PainJ et al.
Surgical options for left sided large bowel emergencies
Ann R Coll Surg Engl
(1991)
DrummJ et al.
The management of acute colonic diverticulitis with suppurative peritonitis
Ann R Coll Surg Engl
(1984)

There are more references available in the full text version of this article.

Cited by (208)

Challenging Surgical Dogma: Controversies in Diverticulitis
2021, Surgical Clinics of North America
Is laparoscopic lavage safe in purulent diverticulitis versus colonic resection? A systematic review and meta-analysis
2019, International Journal of Surgery
Citation Excerpt :
Non-resection alternatives to perforated diverticulitis have been increasingly used. Laparoscopic lavage (LL) was introduced in 1996 by O'Sullivan [4] and has been reported in several consecutive series of LL patients [5]. A retrospective population study from Ireland found that 17% (427/2555) patients were treated only with laparoscopic lavage for diverticulitis between 1995 and 2008.
Diverticulitis is one of the most common gastrointestinal diseases in western population. Colonic resection is recommended by international guidelines as a routinely used technique for purulent diverticulitis. Laparoscopic lavage was introduced as a non-resection alternative. The studies available so far have shown contradictory results. This meta-analysis aims to compare laparoscopic lavage versus colonic resection in patients with Hinchey Ⅲ-Ⅳ diverticulitis.
We did a systematic review of articles published before March 20, 2019, with no language restriction by searching PubMed, Cochrane library, EMBASE databases, clinicaltrials.gov, and Google Scholar databases. We included all RCTs and cohort studies comparing outcomes between patients with Hinchey Ⅲ-Ⅳ diverticulitis undergoing laparoscopic lavage versus colonic resection. Important outcomes were mortality, complications, length of stay, readmission and reoperation rates. We combined data to assess the outcomes using DerSimonian and Laird random-effects model.
A total of 569 patients with diverticulitis of which more than 80% were Hinchey Ⅲ were enrolled from 3 RCTs and 5 cohort studies. Laparoscopic lavage was associated with shorter operative time (WMD -78.9, 95%CI -100.58 to −57.11, P < 0.0001) and total postoperative hospital stay (WMD -7.62, 95%CI -11.60 to −3.63, P = 0.0002) but a higher rate of intra-abdominal abscess (OR 2.69, 95%CI 1.39 to 5.21, P = 0.0032) and secondary peritonitis (OR 5.30, 95%CI 1.91 to 14.73, P = 0.0014).
Laparoscopic lavage for patients with Hinchey Ⅲ to Ⅳ diverticulitis does provide similar mortality, shorter operative time and hospital stay. However, the evidence so far suggests that it might be inadequate for sepsis control and may result in more unplanned reoperations. Further studies are needed to standardize the formal indication for laparoscopic lavage.
Diverticular Disease Management
2019, Shackelford's Surgery of the Alimentary Tract: 2 Volume Set
Diverticulitis is a common problem resulting in more than 300,000 hospital admissions in the United States each year. Approximately 1% to 4% of patients with diverticulosis develop diverticulitis, and approximately one-third of colectomies and colostomies in the United States are performed for diverticular disease. The clinical presentation varies from mild abdominal pain to generalized peritonitis. The chapter updates our current recommendations and changing guidelines for this common disease.
Safety and effectiveness of laparoscopic peritoneal lavage in Hinchey III diverticulitis
2020, Journal of Coloproctology
The management of Hinchey III diverticulitis has been subject to investigation over the years. Hartmann's procedure is widely referred as the standard treatment. However, this option is associated with relevant morbidity and mortality which motivated the arise of alternative interventions such as the laparoscopic peritoneal lavage.
The aim of this review is to synthesize the evidence on the safety and effectiveness of laparoscopic peritoneal lavage in the management of diverticulitis with generalized purulent peritonitis in comparison to resection procedures.
The bibliographic research was conducted using the electronic database Medline from Pubmed. Of the 358 articles identified, our criterious selection resulted in a total of 27 articles for review.
Overall, laparoscopic lavage revealed low mortality rates with no remarkable differences between procedures. The non-randomized studies tended to show lower recurrence and morbidity rates comparatively to the latest RCTs, in the lavage groups, however, no significant differences have been found.
In this review, laparoscopic peritoneal lavage proved to be safe and comparatively effective, although not superior to resection, reaching mixed results. We believe it can be applied as a damage control operation to treat or as a bridge to elective resection. Still, more studies are needed to determine indications and factors for the success of laparoscopic lavage.
O tratamento da diverticulite por Hinchey III tem sido objeto de investigação ao longo dos anos. A operação tipo Hartmann é amplamente referida como o tratamento padrão. No entanto, esta opção está associada à morbilidade e mortalidade relevante, o que motivou o surgimento de intervenções alternativas, como a lavagem peritoneal laparoscópica.
O objetivo desta revisão é sintetizar a evidência sobre a segurança e a eficácia da lavagem peritoneal laparoscópica no tratamento da diverticulite com peritonite generalizada purulenta em comparação com os procedimentos de ressecção.
A pesquisa bibliográfica foi realizada na base de dados eletrónica Medline da Pubmed. Dos 358 artigos identificados, a nossa seleção criteriosa resultou num total de 27 artigos para revisão.
No geral, a lavagem laparoscópica revelou baixas taxas de mortalidade sem diferenças significativas entre os procedimentos. Os estudos não randomizados tenderam a mostrar menores taxas de recorrência e morbilidade comparativamente aos últimos ensaios clínicos randomizados, nos grupos submetidos à lavagem, no entanto, nenhuma diferença significativa foi encontrada.
Nesta revisão, a lavagem peritoneal laparoscópica mostrou-se segura e comparativamente eficaz, embora não superior à ressecção, não alcançando resultados constantes. Nós acreditamos que pode ser aplicada como um procedimento de controlo de danos para tratamento ou como ponte para cirurgia eletiva. Ainda assim, são necessários mais estudos para determinar indicações e fatores para o sucesso da lavagem laparoscópica.
Long-term outcomes and risk factors for diverticulitis recurrence after a successful laparoscopic peritoneal lavage in Hinchey III peritonitis
2023, International Journal of Colorectal Disease
New Trends in Laparoscopic Procedures in the Emergency Abdominal Surgery
2023, The High-Risk Surgical Patient

View all citing articles on Scopus

^**: A video of this technique was shown at M.I.M.S., Florida 1993.

View full text

Laparoscopic management of generalized peritonitis due to perforated colonic diverticula**

Purpose

Patients and Methods

Results

Am J Surg

Am J Surg

Surgical options for left sided large bowel emergencies

Ann R Coll Surg Engl

The management of acute colonic diverticulitis with suppurative peritonitis

Ann R Coll Surg Engl