Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a systematic review

Area of Science:

• Gastroenterology
• Surgical Innovation
• Minimally Invasive Surgery

Background:

• Perforated diverticulitis presents significant clinical challenges.
• Current management strategies for perforated diverticulitis carry risks of morbidity and mortality.
• Laparoscopic peritoneal lavage (LPL) is an alternative treatment modality.

Purpose of the Study:

• To systematically review the efficacy, morbidity, and mortality associated with laparoscopic peritoneal lavage for perforated diverticulitis.
• To evaluate the outcomes of LPL in patients with perforated colonic diverticulitis.

Main Methods:

• Comprehensive literature search across multiple databases (PubMed, EMBASE, Web of Science, Cochrane Library, CINAHL, Google Scholar) without language restriction.
• Inclusion of all studies reporting the use of LPL for perforated diverticulitis.
• Data extraction from selected prospective cohort studies, retrospective case series, and case reports.

Main Results:

• Analysis of 231 patients, with 77% presenting with purulent peritonitis (Hinchey III).
• Laparoscopic peritoneal lavage achieved successful control of abdominal and systemic sepsis in 95.7% of patients.
• Low reported mortality (1.7%), morbidity (10.4%), and minimal colostomy requirement (1.7%).

Conclusions:

• Published literature indicates promising outcomes for LPL in perforated diverticulitis, despite a lack of high-quality studies.
• LPL demonstrates high efficacy in managing sepsis.
• The procedure is associated with low mortality, low morbidity, and a reduced need for colostomy.