Laparoscopic peritoneal lavage versus laparoscopic sigmoidectomy in complicated acute diverticulitis: a multicenter prospective observational study

Dario Tartaglia, Salomone Di Saverio, Weronika Stupalkowska, Sandro Giannessi, Virna Robustelli, Federico Coccolini, Orestis Ioannidis, Gabriela Elisa Nita, Virginia María Durán Muñoz-Cruzado, Felipe Pareja Ciuró, Massimo Chiarugi

Research output: Contribution to journalArticle

Abstract

Purpose: Laparoscopic peritoneal lavage (LPL) is feasible in selected patients with pelvic abscess and generalized purulent peritonitis caused by acute diverticulitis. We aimed to compare LPL and laparoscopic sigmoidectomy (LS) in complicated acute diverticulitis. Methods: This prospective, observational, multicenter study included patients with a pelvic abscess not amenable to conservative management and patients with Hinchey III acute diverticulitis, from 2015 to 2018. Sixty-six patients were enrolled: 28 (42%) underwent LPL and 38 (58%) underwent LS. In LS, patients had a primary anastomosis, with or without ileostomy, or an end colostomy (HA). Major outcomes were mortality, morbidity, failure of source control, reoperation, length of stay, and diverticulitis recurrence. Results: Patient demographics were similar in the two groups. In LPL, ASA score > 2 and Mannheim Peritonitis Index were significantly higher (p = 0.05 and 0.004). In LS, 24 patients (63%) had a PA and 14 (37%) an HA. No death was recorded. Overall, morbidity was 33% in LPL and 18% in LS (p = 0.169). However, failure to achieve source control of the peritoneal infection and the need to return to the operating room were more frequent in LPL (p = 0.002 and p = 0.006). Mean postoperative length of stay was comparable (p = 0.08). Diverticular recurrence was significantly higher in LPL (p = 0.003). Conclusion: LPL is related to a higher reoperation rate, more frequent postoperative ongoing sepsis, and higher recurrence rates. Therefore, laparoscopic lavage for perforated diverticulitis carries a high risk of failure in daily practice.

Original languageEnglish
Pages (from-to)2111-2120
Number of pages10
JournalInternational Journal of Colorectal Disease
Volume34
Issue number12
DOIs
Publication statusPublished - Dec 1 2019
Externally publishedYes

Keywords

  • Complicated acute diverticulitis
  • Hartmann’s procedure
  • Laparoscopic lavage
  • Laparoscopic sigmoidectomy
  • Resection–anastomosis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Laparoscopic peritoneal lavage versus laparoscopic sigmoidectomy in complicated acute diverticulitis : a multicenter prospective observational study. / Tartaglia, Dario; Di Saverio, Salomone; Stupalkowska, Weronika; Giannessi, Sandro; Robustelli, Virna; Coccolini, Federico; Ioannidis, Orestis; Nita, Gabriela Elisa; Muñoz-Cruzado, Virginia María Durán; Ciuró, Felipe Pareja; Chiarugi, Massimo.

In: International Journal of Colorectal Disease, Vol. 34, No. 12, 01.12.2019, p. 2111-2120.

Research output: Contribution to journalArticle

Tartaglia, D, Di Saverio, S, Stupalkowska, W, Giannessi, S, Robustelli, V, Coccolini, F, Ioannidis, O, Nita, GE, Muñoz-Cruzado, VMD, Ciuró, FP & Chiarugi, M 2019, 'Laparoscopic peritoneal lavage versus laparoscopic sigmoidectomy in complicated acute diverticulitis: a multicenter prospective observational study', International Journal of Colorectal Disease, vol. 34, no. 12, pp. 2111-2120. https://doi.org/10.1007/s00384-019-03429-5
Tartaglia, Dario ; Di Saverio, Salomone ; Stupalkowska, Weronika ; Giannessi, Sandro ; Robustelli, Virna ; Coccolini, Federico ; Ioannidis, Orestis ; Nita, Gabriela Elisa ; Muñoz-Cruzado, Virginia María Durán ; Ciuró, Felipe Pareja ; Chiarugi, Massimo. / Laparoscopic peritoneal lavage versus laparoscopic sigmoidectomy in complicated acute diverticulitis : a multicenter prospective observational study. In: International Journal of Colorectal Disease. 2019 ; Vol. 34, No. 12. pp. 2111-2120.
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abstract = "Purpose: Laparoscopic peritoneal lavage (LPL) is feasible in selected patients with pelvic abscess and generalized purulent peritonitis caused by acute diverticulitis. We aimed to compare LPL and laparoscopic sigmoidectomy (LS) in complicated acute diverticulitis. Methods: This prospective, observational, multicenter study included patients with a pelvic abscess not amenable to conservative management and patients with Hinchey III acute diverticulitis, from 2015 to 2018. Sixty-six patients were enrolled: 28 (42{\%}) underwent LPL and 38 (58{\%}) underwent LS. In LS, patients had a primary anastomosis, with or without ileostomy, or an end colostomy (HA). Major outcomes were mortality, morbidity, failure of source control, reoperation, length of stay, and diverticulitis recurrence. Results: Patient demographics were similar in the two groups. In LPL, ASA score > 2 and Mannheim Peritonitis Index were significantly higher (p = 0.05 and 0.004). In LS, 24 patients (63{\%}) had a PA and 14 (37{\%}) an HA. No death was recorded. Overall, morbidity was 33{\%} in LPL and 18{\%} in LS (p = 0.169). However, failure to achieve source control of the peritoneal infection and the need to return to the operating room were more frequent in LPL (p = 0.002 and p = 0.006). Mean postoperative length of stay was comparable (p = 0.08). Diverticular recurrence was significantly higher in LPL (p = 0.003). Conclusion: LPL is related to a higher reoperation rate, more frequent postoperative ongoing sepsis, and higher recurrence rates. Therefore, laparoscopic lavage for perforated diverticulitis carries a high risk of failure in daily practice.",
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T1 - Laparoscopic peritoneal lavage versus laparoscopic sigmoidectomy in complicated acute diverticulitis

T2 - a multicenter prospective observational study

AU - Tartaglia, Dario

AU - Di Saverio, Salomone

AU - Stupalkowska, Weronika

AU - Giannessi, Sandro

AU - Robustelli, Virna

AU - Coccolini, Federico

AU - Ioannidis, Orestis

AU - Nita, Gabriela Elisa

AU - Muñoz-Cruzado, Virginia María Durán

AU - Ciuró, Felipe Pareja

AU - Chiarugi, Massimo

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N2 - Purpose: Laparoscopic peritoneal lavage (LPL) is feasible in selected patients with pelvic abscess and generalized purulent peritonitis caused by acute diverticulitis. We aimed to compare LPL and laparoscopic sigmoidectomy (LS) in complicated acute diverticulitis. Methods: This prospective, observational, multicenter study included patients with a pelvic abscess not amenable to conservative management and patients with Hinchey III acute diverticulitis, from 2015 to 2018. Sixty-six patients were enrolled: 28 (42%) underwent LPL and 38 (58%) underwent LS. In LS, patients had a primary anastomosis, with or without ileostomy, or an end colostomy (HA). Major outcomes were mortality, morbidity, failure of source control, reoperation, length of stay, and diverticulitis recurrence. Results: Patient demographics were similar in the two groups. In LPL, ASA score > 2 and Mannheim Peritonitis Index were significantly higher (p = 0.05 and 0.004). In LS, 24 patients (63%) had a PA and 14 (37%) an HA. No death was recorded. Overall, morbidity was 33% in LPL and 18% in LS (p = 0.169). However, failure to achieve source control of the peritoneal infection and the need to return to the operating room were more frequent in LPL (p = 0.002 and p = 0.006). Mean postoperative length of stay was comparable (p = 0.08). Diverticular recurrence was significantly higher in LPL (p = 0.003). Conclusion: LPL is related to a higher reoperation rate, more frequent postoperative ongoing sepsis, and higher recurrence rates. Therefore, laparoscopic lavage for perforated diverticulitis carries a high risk of failure in daily practice.

AB - Purpose: Laparoscopic peritoneal lavage (LPL) is feasible in selected patients with pelvic abscess and generalized purulent peritonitis caused by acute diverticulitis. We aimed to compare LPL and laparoscopic sigmoidectomy (LS) in complicated acute diverticulitis. Methods: This prospective, observational, multicenter study included patients with a pelvic abscess not amenable to conservative management and patients with Hinchey III acute diverticulitis, from 2015 to 2018. Sixty-six patients were enrolled: 28 (42%) underwent LPL and 38 (58%) underwent LS. In LS, patients had a primary anastomosis, with or without ileostomy, or an end colostomy (HA). Major outcomes were mortality, morbidity, failure of source control, reoperation, length of stay, and diverticulitis recurrence. Results: Patient demographics were similar in the two groups. In LPL, ASA score > 2 and Mannheim Peritonitis Index were significantly higher (p = 0.05 and 0.004). In LS, 24 patients (63%) had a PA and 14 (37%) an HA. No death was recorded. Overall, morbidity was 33% in LPL and 18% in LS (p = 0.169). However, failure to achieve source control of the peritoneal infection and the need to return to the operating room were more frequent in LPL (p = 0.002 and p = 0.006). Mean postoperative length of stay was comparable (p = 0.08). Diverticular recurrence was significantly higher in LPL (p = 0.003). Conclusion: LPL is related to a higher reoperation rate, more frequent postoperative ongoing sepsis, and higher recurrence rates. Therefore, laparoscopic lavage for perforated diverticulitis carries a high risk of failure in daily practice.

KW - Complicated acute diverticulitis

KW - Hartmann’s procedure

KW - Laparoscopic lavage

KW - Laparoscopic sigmoidectomy

KW - Resection–anastomosis

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