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Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis
E Myers1, M Hurley, G C O'Sullivan
1Institute for Clinical Outcomes Research and Education at Saint Vincent's University Hospital, Dublin, Ireland.
The British Journal of Surgery
|December 14, 2007
Summary
Laparoscopic peritoneal lavage is a feasible treatment for generalized peritonitis from perforated diverticulitis, showing low morbidity and recurrence rates. This minimally invasive approach offers a viable alternative to traditional open surgery.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Minimally Invasive Surgery
Background:
- Generalized peritonitis from perforated diverticulitis traditionally requires open surgery.
- This study investigates the feasibility of laparoscopic peritoneal lavage as an alternative approach.
Purpose of the Study:
- To assess the feasibility and outcomes of laparoscopic peritoneal lavage for perforated diverticulitis with generalized peritonitis.
- To evaluate operative success, symptom resolution, morbidity, mortality, and recurrence rates.
Main Methods:
- A prospective, multi-institutional study involving 100 patients with perforated diverticulitis and generalized peritonitis.
- Patients underwent attempted laparoscopic peritoneal lavage, with peritonitis severity assessed using the Hinchey grading system.
Main Results:
- Laparoscopic lavage was successful in 92 patients; 8 required conversion to open Hartmann's procedure for grade 4 diverticulitis.
- Morbidity and mortality rates were 4% and 3%, respectively. Postoperative pelvic abscess occurred in 2 patients.
- Low recurrence rate observed, with only 2 patients re-presenting with diverticulitis at a median follow-up of 36 months.
Conclusions:
- Laparoscopic management of perforated diverticulitis with generalized peritonitis is feasible.
- This approach demonstrates low short-term recurrence risk.
- Laparoscopic peritoneal lavage presents a viable minimally invasive option for this condition.
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