Laparoscopic Lavage for Perforated Diverticulitis With Purulent Peritonitis: A Randomized Trial

Area of Science:

• Gastroenterology
• Surgical Innovation
• Clinical Trials

Background:

• Perforated diverticulitis with purulent peritonitis traditionally requires open colon resection and stoma formation, associated with high risks.
• Laparoscopic lavage has emerged as a potential definitive treatment alternative.

Purpose of the Study:

• To compare the efficacy and safety of laparoscopic lavage versus the Hartmann procedure for perforated diverticulitis with purulent peritonitis.

Main Methods:

• A randomized, controlled, multicenter, open-label trial involving 9 hospitals in Sweden and Denmark.
• Patients with confirmed Hinchey grade III perforated diverticulitis and purulent peritonitis were randomized to either laparoscopic lavage or the Hartmann procedure.
• Primary outcome was the rate of reoperations within 12 months; secondary outcomes included hospital readmissions, total hospital stay, and adverse events.

Main Results:

• Fewer patients undergoing laparoscopic lavage (27.9%) required reoperations within 12 months compared to the Hartmann procedure (62.5%), a 59% relative risk reduction.
• The laparoscopic group experienced a 35% shorter total hospital stay within 12 months.
• Mortality and severe adverse events were similar between the two groups, and fewer patients in the laparoscopic group retained a stoma after 12 months.

Conclusions:

• Laparoscopic lavage is associated with a significantly reduced need for reoperations in acute perforated diverticulitis with purulent peritonitis.
• The procedure demonstrates a comparable safety profile to the Hartmann procedure.
• Laparoscopic lavage may represent an appropriate treatment of choice for this condition.