Benefits of laparoscopic peritoneal lavage for complicated sigmoid diverticulitis

Favuzza, Joanne; Friel, John C.; Kelly, John J.; Perugini, Richard A.; Counihan, Timothy C.

doi:10.1007/s00384-009-0641-2

Cited by 62 publications

(44 citation statements)

References 23 publications

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“…Several other non comparative studies that were conducted later showed similar results [13,14,15,16,17,18]. Despite being a relatively small series, our initial experience suggests that despite a high rate of initial success, a significant portion of patients undergoing laparoscopic peritoneal lavage and drainage may suffer from persistent symptoms requiring further surgery with segmental resection.…”

Section: Discussionsupporting

confidence: 62%

Early Experience with Laparoscopic Lavage in Acute Complicated Diverticulitis

Horesh

Zbar²,

Haim³

et al. 2015

Dig Surg

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Background: Contemporary surgical management of complicated diverticulitis is controversial. Traditionally, the gold standard has been resection and colostomy, but recently peritoneal lavage and drainage without resection in cases of purulent peritonitis have been suggested. This study aims to review our initial experience with laparoscopic peritoneal lavage for complicated diverticulitis. Methods: Retrospective review of all patients who underwent emergent peritoneal lavage and drainage for acute complicated diverticulitis. Results: Five-hundred-thirty-eight patients admitted for acute diverticulitis between 2007 and 2012 were recorded in the database. Thirty seven underwent emergent surgery of which 10 had peritoneal lavage and drainage without colonic resection for complicated diverticulitis causing peritonitis. Peritoneal lavage and drainage resulted in the resolution of acute symptoms in all cases. In long-term follow-up, 3 (30%) patients required elective resection owing to symptomatic disease, two of these due to recurrent diverticulitis, and one owing to complicated fistula following the procedure. Conclusion: Peritoneal lavage is a feasible option for complicated diverticulitis with purulent non-fecal peritonitis, but a significant portion of the patients may require elective resection. Comparative studies with emergent resection are needed to determine the role of peritoneal lavage in complicated diverticulitis.

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Section: Discussionsupporting

confidence: 62%

Early Experience with Laparoscopic Lavage in Acute Complicated Diverticulitis

Horesh

Zbar²,

Haim³

et al. 2015

Dig Surg

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“…Recent evidence suggests that lavage could be used as a first line in treatment of diverticulitis, if not to cure the disease, at least to prevent a colostomy during subsequent surgery. Also for complications after bowel surgery, lavage is suggested [8][9][10][11][12][13][14][15][16]. RCTs to confirm the beneficial effect of lavage in diverticulitis have been initiated in the Netherlands [23] and in Scandinavia.…”

Section: Discussionmentioning

confidence: 99%

“…Although lavage during laparoscopy is more efficient than during laparotomy [3], its usefulness remains controversial [4][5][6][7]. Over the last years, extensive peritoneal lavage during laparoscopy was reported to be useful for the treatment of complications following colorectal surgery and for diverticulitis [8][9][10][11][12][13][14][15][16]. In animal models, lavage decreases adhesion formation following peritonitis [17].…”

Section: Introductionmentioning

confidence: 99%

Extensive peritoneal lavage decreases postoperative C-reactive protein concentrations: a RCT

et al. 2015

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Although extensive lavage is useful in peritoneal infections as diverticulitis, the extent of peritoneal lavage that should be used at the end of surgery is unclear. A randomised controlled trial comparing standard lavage with 0.5 litre (L) with extensive 8-L lavage was performed in 20 consecutive patients, following a full thickness resection of the rectum for deep endometriosis. Randomisation was done by the research nurse using sealed envelopes. Endpoints were C-reactive protein (CRP) concentration, white blood cell (WBC) count, temperature and the occurrence of complications. After lavage with 8 L, the CRP concentrations were consistently lower than that after lavage with 0.5 L and this from day 1 to day 7 after surgery (P=0.01). Rigorous peritoneal lavage seems preferable when a risk of pelvic contamination exists. Clinicaltrials.gov registration: NCT00930696

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“…The first published study of patients undergoing laparoscopic lavage for generalized purulent peritonitis due to perforated diverticular disease reported that all eight patients made a complete recovery, with no patient requiring further surgical intervention in the 12-to 48-month follow-up period [47]. Subsequent small series also concluded that laparoscopic lavage is a safe and effective alternative to colectomy in patients with diffuse purulent peritonitis [48][49][50][51][52][53][54][55]. The largest published series to date included 100 patients with generalized peritonitis and radiological evidence of pneumoperitoneum [56]; 92 of these were managed by laparoscopic lavage, and all eight patients with faecal peritonitis were converted to an open Hartmann's procedure.…”

Section: The Role Of Laparoscopic Peritoneal Lavagementioning

confidence: 99%

Management of Acute Diverticulitis and its Complications

Welbourn

Hartley

2014

Indian J Surg

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Colonic diverticular disease is a common condition, and around a quarter of people affected by it will experience acute symptoms at some time. The most common presentation is uncomplicated acute diverticulitis that can be managed conservatively with bowel rest and antibiotics. However, some patients will present with diverticular abscesses or purulent or faeculent peritonitis due to perforated diverticular disease. Whilst most mesocolic abscesses can be managed with percutaneous drainage alone, pelvic abscesses are associated with a higher rate of future complications and usually require percutaneous drainage followed by interval sigmoid resection. Patients who require emergency surgery for complicated acute diverticulitis most commonly undergo a Hartmann's procedure, although resection with primary anastomosis and laparoscopic peritoneal lavage have emerged as alternative treatment options for patients with purulent peritonitis in recent years. However, robust evidence from randomized trials is lacking for these alternative procedures, and the studies that have reported good outcomes from them have included carefully selected patient groups. There has been a move away from recommending elective prophylactic colectomy after two episodes of acute diverticulitis in the light of evidence that most patients will not experience a significant recurrence of their symptoms; elective surgery is indicated for those with ongoing symptoms, pelvic abscesses, complications-such as fistulating disease, strictures or recurrent diverticular bleeding-and those who are at high risk of perforation during future episodes, for example, due to immunosuppression, chronic renal failure or collagen-vascular diseases.

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Benefits of laparoscopic peritoneal lavage for complicated sigmoid diverticulitis

Abstract: We conclude that laparoscopic exploration and peritoneal lavage can be performed safely in patients with diffuse, purulent peritonitis. Using this approach, most patients with purulent peritonitis can avoid emergent laparotomy with the risk of colostomy, and the need for a second surgery.

Cited by 62 publications

References 23 publications

Early Experience with Laparoscopic Lavage in Acute Complicated Diverticulitis

Early Experience with Laparoscopic Lavage in Acute Complicated Diverticulitis

Extensive peritoneal lavage decreases postoperative C-reactive protein concentrations: a RCT

Management of Acute Diverticulitis and its Complications

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