Surgical Decision-making for the Treatment of Acute Diverticulitis: a Single-centre Retrospective Study

Abstract

BACKGROUND: Several studies suggest that laparoscopic peritoneal lavage might be associated with an increased event rate. The WSES guidelines recommend performing laparoscopic peritoneal lavage only in highly selected patients; however, selection criteria remain poorly described. OBJECTIVE: This study aimed to assess the complication and long-term outcomes of the lavage group, and to report our experience of acute diverticulitis. DESIGN: This was based on a retrospective cohort study. SETTINGS: This was a study conducted in Fondazione Macchi, Italy. PATIENTS: Patients presenting with acute diverticulitis and undergoing surgery in the hospital of Varese between 2018 and 2022 were included. INTERVENTION: Operative management of acute sigmoid diverticulitis was involved, in particular laparoscopic peritoneal lavage, primary resection and the Hartmann procedure. MAIN OUTCOME MEASURES: The main outcome measures were short-term and long-term outcomes. RESULTS: Long-term follow-up showed the occurrence of complications Clavien-Dindo ≥ 2 in 21.9% (16/73) of patients in the sigmoidectomy group versus 61.1% (11/18) of patients in the lavage group. Among the 11 patients complicated after laparoscopic lavage, 9 required a second surgery. After a comparison between the complicated and uncomplicated patients who were managed with laparoscopic lavage, descriptive differences were found regarding the BMI (95% CI, 21.7-24.3 vs 95% CI, 24.7-31.3, p=0.0419). In analysis, BMI ≥ 27 Kg/m2 (OR, 16 p=0.049) was associated with short and long-term complications in the lavage group. There was no evidence for an association between complications and BMI ≥ 27 Kg/m2 in the primary resection (OR, 1.61 p=1) and the Hartmann procedure group (OR, 4.25 p=0.1438). LIMITATIONS: The study was limited by its retrospective nature and small sample size. CONCLUSIONS: Perforated colonic diverticulitis treated with laparoscopic peritoneal lavage was associated with a high morbidity rate; however, BMI could be a prognostic factor for long-term outcomes, including recurrent diverticulitis and the occurrence of abscesses.