Laparoscopic resection and primary anastomosis for perforated diverticulitis: with or without loop ileostomy?

Area of Science:

• Gastroenterology
• Surgical Innovation
• Colorectal Surgery

Background:

• Laparoscopic resection with primary anastomosis (RPA) shows promise for perforated diverticulitis.
• The necessity of a diverting ileostomy in conjunction with RPA for Hinchey III diverticulitis remains uncertain.

Purpose of the Study:

• To evaluate the outcomes of laparoscopic RPA with and without a proximal diversion in patients diagnosed with Hinchey III diverticulitis.

Main Methods:

• A retrospective analysis was conducted on patients who underwent laparoscopic sigmoidectomy for perforated Hinchey III diverticulitis between 2000 and 2019.
• Patients were categorized into two groups: those who underwent RPA without diversion and those who had RPA with a protective ileostomy.
• Key outcomes assessed included 30-day morbidity, mortality, length of hospital stay, and urgent reoperation rates.

Main Results:

• Mortality, urgent reoperation, and anastomotic leak rates were comparable between the RPA without diversion group (n=76) and the RPA with ileostomy group (n=18).
• The group with a proximal ileostomy experienced significantly higher overall morbidity (55.6% vs. 27.6%) and readmission rates (11.1% vs. 1.3%).
• Patients with a proximal ileostomy also had a longer length of hospital stay (9.2 vs. 6.3 days) and operative time (230.2 vs. 182.4 minutes).

Conclusions:

• Laparoscopic RPA is a viable option for selected patients with Hinchey III diverticulitis.
• The addition of a proximal ileostomy in this context was associated with increased morbidity, readmissions, and extended hospital stays.
• Further research is warranted to identify specific patient subgroups who may benefit from proximal diversion.