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Early experience with laparoscopic lavage for perforated diverticulitis.
H A Swank1, I M Mulder, A G M Hoofwijk
1Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
The British Journal of Surgery
|February 14, 2013
Summary
Laparoscopic lavage is a feasible treatment for perforated diverticulitis, successfully controlling sepsis in most patients. Careful patient selection and identification of sigmoid perforation are crucial for optimal outcomes.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Diverticular Disease Management
Background:
- Laparoscopic lavage is an emerging alternative to sigmoid resection for perforated diverticulitis.
- This study evaluates the initial clinical experience with laparoscopic lavage.
Purpose of the Study:
- To assess the feasibility and outcomes of laparoscopic lavage in treating perforated diverticulitis.
- To identify factors influencing the success of laparoscopic lavage.
Main Methods:
- Retrospective review of patients with complicated diverticulitis across 34 Dutch teaching hospitals.
- Inclusion of patients with perforated diverticulitis treated with laparoscopic lavage between January 2008 and December 2010.
Main Results:
- Laparoscopic lavage was performed in 38 patients, successfully controlling sepsis in 31 (81.6%).
- Morbidity was 32% (10/31) with fast recovery in successful cases. Overall complications occurred in 17 patients.
- Mortality included two cases of multiple organ failure and one of aspiration pneumonia. Three patients later underwent sigmoid resection for recurrent diverticulitis.
Conclusions:
- Laparoscopic lavage is feasible for the majority of perforated diverticulitis cases.
- Accurate identification of sigmoid perforation and appropriate patient selection are critical for successful treatment.
- Factors like co-morbidities, C-reactive protein, and Mannheim Peritonitis Index may predict lavage failure.
