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 language | English |
|---|---|
| Pages (from-to) | 2111-2120 |
| Number of pages | 10 |
| Journal | International Journal of Colorectal Disease |
| Volume | 34 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - Dec 1 2019 |
| Externally published | Yes |
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 journal › Article
}
TY - JOUR
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
PY - 2019/12/1
Y1 - 2019/12/1
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
UR - http://www.scopus.com/inward/record.url?scp=85075189101&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075189101&partnerID=8YFLogxK
U2 - 10.1007/s00384-019-03429-5
DO - 10.1007/s00384-019-03429-5
M3 - Article
C2 - 31713714
AN - SCOPUS:85075189101
VL - 34
SP - 2111
EP - 2120
JO - International Journal of Colorectal Disease
JF - International Journal of Colorectal Disease
SN - 0179-1958
IS - 12
ER -