Preliminary experience with laparoscopic peritoneal lavage for complicated diverticulitis: a new algorithm for...

Area of Science:

• Gastroenterology
• Surgical Innovation
• Minimally Invasive Surgery

Background:

• Perforated diverticulitis often leads to colostomy, impacting patient morbidity and quality of life.
• Literature suggests reduced laparotomy and colostomy rates when diagnostic laparoscopy indicates no fecal peritonitis.

Purpose of the Study:

• To evaluate the feasibility and safety of diagnostic laparoscopy and laparoscopic peritoneal lavage in managing diverticulitis.
• To propose a novel algorithm incorporating these techniques for hospitalized diverticulitis patients.

Main Methods:

• Ten patients with diverticulitis underwent diagnostic laparoscopy between May 2009 and February 2012.
• An algorithm was developed for medical and surgical management, including diagnostic laparoscopy and laparoscopic peritoneal lavage for Hinchey Stage 3 or undrainable abscesses.
• Eight patients received laparoscopic peritoneal lavage; two required conversion to open procedures.

Main Results:

• Zero mortality was observed in the study cohort.
• Four patients were readmitted for recurrence; two of these were diagnosed with adenocarcinoma and two underwent elective laparoscopic sigmoid colon resection.
• Diagnostic laparoscopy and lavage were feasible and safe, avoiding immediate laparotomy and colostomy in most cases.

Conclusions:

• Diagnostic laparoscopy and laparoscopic peritoneal lavage are safe and effective alternatives for select diverticulitis patients.
• This approach can help avoid immediate colostomy and facilitate staging for subsequent elective laparoscopic resection.
• A novel algorithm incorporating these minimally invasive techniques is proposed for hospitalized diverticulitis management.