Resection preferable to lavage in perforated diverticulitis

Last Updated: 2015-10-12

By David Douglas

NEW YORK (Reuters Health) - Colon resection is preferable to laparoscopic lavage in cases of suspected acute perforated diverticulitis, according to Scandinavian researchers.

"In contrast to previous non-randomized trials, our multi-center randomized study shows that laparoscopic lavage in management of patients with perforated diverticulitis does not reduce severe complications and bears a higher risk of reoperations compared to traditional surgical removal of the diseased bowel," Dr. Johannes Kurt Schultz told Reuters Health by email.

In an October 6 online paper in JAMA, Dr. Schultz, of Akershus University Hospital, Lorenskog, Norway, and colleagues report on 199 patients from 21 centers in Sweden and Norway who were randomly assigned to laparoscopic peritoneal lavage or colon resection.

Three patients in each group underwent oncological resection rather than a diverticulitis procedure when colon cancers were found during the study procedure.

There was no significant difference in 90-day rates of severe complications (30.7% with lavage and 26.0% with resection) or in mortality (13.9% versus 11.5%).

Operating time was significantly shorter in the lavage group, but there was no significant difference in quality of life or in length of hospital stay.

However, in the 74 lavage and 70 resection patients included in assessment of secondary outcomes, the reoperation rate was significantly higher in the lavage group (20.3% versus 5.7%). Intra-abdominal infections (secondary peritonitis and abscesses) were also more frequent in the lavage group.

In addition, four sigmoid carcinomas were missed in the lavage group.

"Thus," concluded Dr. Schultz "laparoscopic lavage cannot be recommended as a standard treatment for these patients."

Commenting by email, Dr. Scott A. Strong, coauthor of an editorial, told Reuters Health, "The study showed that the less invasive operation for diverticulitis complicated by abscess or purulent peritonitis was more likely to result in a subsequent abdominal infection or repeat operation."

Dr. Strong, of Northwestern University Feinberg School of Medicine, Chicago, added, "The fact that four cancers were missed in the laparoscopic group is also somewhat disconcerting."

The South-Eastern Norway Regional Health Authority partially funded this research.

SOURCE: http://bit.ly/1GEz77W and http://bit.ly/1NjwwYE

JAMA 2015.