Laparoscopic lavage effective for perforated diverticulitis

Last Updated: 2015-01-05

By David Douglas

NEW YORK (Reuters Health) - Laparoscopic lavage for perforated diverticulitis with purulent peritonitis is feasible and as safe as open surgery, according to Swedish researchers.

"Our study has, together with a few others, shown that laparoscopic surgery itself seems to reduce the risk of small bowel obstruction after surgery," Dr. Eva Angenete of the University of Gothenburg in Sweden told Reuters Health by email. "It is probable that patients should, if possible, be operated on with a laparoscopic approach to reduce the risk of readmission and future surgery."

In a December 8 online paper in the Annals of Surgery, Dr Angenete and colleagues note that perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with open surgery, including colon resection and stoma (the Hartmann procedure).

To investigate whether a laparoscopic approach might be more suitable, the researchers enrolled 83 patients in a randomized trial, of whom 77 were available for analysis (39 who had laparoscopic lavage and 36 who underwent the Hartmann procedure).

The 90-day mortality rates were comparable in the two groups: 11.4% in the Hartmann group and 7.7% in the laparoscopic patients. Corresponding 30-day reoperation rates came to 17.1% and 13.2%. The laparoscopic group also had shorter postoperative hospital stays was (6 versus 9 days).

"Compared with patients undergoing Hartmann's resection, patients treated with laparoscopic lavage were no different in regard to overall morbidity and short-term mortality," the researchers write. "The patients also had shorter duration of surgery and shorter hospital stay after laparoscopic lavage."

The researchers go on to point out that if the long-term results of the present trial, together with the results of other ongoing randomized trials, support the safety of laparoscopic lavage, "then hopefully patients may avoid colon resection and stoma creation and hence some of the well-known short- and long-term complications."

This study was funded by several foundations and organizations. The authors report no disclosures.

SOURCE: http://bit.ly/1vT7P6Y

Ann Surg 2014.