Emergency Laparoscopic Management of Perforated Sigmoid Diverticulitis: A Promising Alternative to More Radical Procedures

Brétagnol, F.; Pautrat, Karine; Mor, Caroline; Benchellal, Zin; Huten, N.; Calan, L. De

doi:10.1016/j.jamcollsurg.2007.11.018

Cited by 100 publications

(78 citation statements)

References 22 publications

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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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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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“…This strategy, which aims to convert generalized purulent peritonitis to localized diverticulitis that can be safely treated with antibiotic therapy, is successful in most cases ([90 %), with immediate improvement of the clinical conditions of the patient, and is associated with decreased mortality and morbidity (particularly SS complications such as dehiscence, SS infection, and incisional hernia) (LE 3a) [223][224][225][226][227][228][229][230][231]. After peritoneal lavage and drainage, elective colonic resection can be planned within 3-6 months, but some authors actually propose limiting treatment to simple peritoneal lavage and not to proceed to sigmoid resection [232].…”

Section: Acute Diverticulitismentioning

confidence: 99%

“…Hinchey III patients in whom exploration of the abdomen is not satisfactory because of adhesions or obstruction and patients with severe peritonitis with numerous false membranes should be considered for conversion to open surgery [223,224,226] or should undergo laparoscopic emergency colonic resection, but only if performed by experienced hands (LE 3b) [233][234][235]. Of note, elective resection of the diseased segment decreases the risk of conversion and increases the rate of primary anastomosis compared to emergency surgery (LE 5).…”

Section: Acute Diverticulitismentioning

confidence: 99%

Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)

et al. 2012

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Background In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. Methods Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association.

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“…La experiencia inicial ha sido prometedora con respecto a la mortalidad perioperatoria y las complicaciones 30 . Es más, si bien la mayoría de los que proponen el LPL inicial, proponen una sigmoidectomía electiva diferida 33,[37][38][39][40] , un estudio multicéntrico irlandés reportó alentadores resultados luego del lavado seguido de una observación continua. De hecho, Myers 41 , encontró recurrencia de diverticulitis de sigmoides en 4 de 92 pacientes tratados, ninguno de los cuales requirieron cirugía en el seguimiento de hasta 36 meses.…”

Section: Alternativas De Manejo Quirúrgico Para La Diverticulitis Aguunclassified

Diverticulitis aguda complicada: tendencias en el tratamiento actual

Readi

et al. 2012

Rev Chil Cir

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Acute complicated diverticulitis. New trends in treatmentDiverticular disease refers to the presence of colon diverticula. Its prevalence increases with age and in a few cases present as diverticulitis. Acute complicated diverticulitis is potentially mortal, since it can perforate and require emergency surgery. the treatment of choice is the excision of the perforated segment and the creation of a proximal colostomy. there are other therapeutic alternatives such as excision with primary anastomosis and novel approaches such as laparoscopic peritoneal lavage. We herein review the new treatments of acute diverticulitis.Key words: Diverticular disease, diverticulitis, colectomy, laparoscopic lavage. ResumenLa enfermedad diverticular se refiere a la presencia de divertículos en el colon. Su prevalencia aumenta con la edad y sólo en pocos casos se presenta como diverticulitis aguda. La diverticulitis aguda complicada es una condición potencialmente mortal, por la posibilidad de una perforación libre que requiera cirugía de urgencia. El tratamiento de elección en la mayoría de los casos es la resección del segmento colónico que incluya la perforación y la creación de una colostomía proximal. Existen otros tratamientos en el manejo quirúrgico de la diverticulitis perforada, como la resección con anastomosis primaria y nuevas aproximaciones, como el lavado peritoneal por vía laparoscópica. Se revisa y discute en este artículo la tendencia actual en el manejo de la diverticulitis aguda perforada.Palabras clave: Enfermedad diverticular, diverticulitis aguda, colectomía, lavado peritoneal laparoscópico.

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Emergency Laparoscopic Management of Perforated Sigmoid Diverticulitis: A Promising Alternative to More Radical Procedures

Cited by 100 publications

References 22 publications

Management of Acute Diverticulitis and its Complications

Management of Acute Diverticulitis and its Complications

Diverticulitis aguda complicada: tendencias en el tratamiento actual

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