Laparoscopic lavage for perforated diverticulitis in the LapLav study: population-based registry study

Area of Science:

• Gastroenterology
• Surgical Innovation
• Public Health

Background:

• Perforated diverticulitis with peritonitis (Hinchey III) traditionally treated with resection.
• Laparoscopic lavage emerges as a viable alternative based on recent trials.
• This study evaluates laparoscopic lavage safety in a national, real-world registry.

Purpose of the Study:

• To assess the safety and effectiveness of laparoscopic lavage versus resection for Hinchey III perforated diverticulitis.
• To compare complication rates, hospital stay, and readmissions between the two surgical approaches.
• To provide real-world evidence on laparoscopic lavage beyond controlled trial settings.

Main Methods:

• Registry-based study of 499 patients in Sweden (2016-2018).
• Emergency surgery for perforated diverticulitis.
• Inverse probability weighting by propensity score used for confounding factor adjustment.

Main Results:

• Laparoscopic lavage showed a significantly lower 90-day Comprehensive Complication Index (20.9 vs. 32.0) and shorter hospital stay (9 vs. 15 days).
• Readmission rates were higher after lavage (27.2% vs. 21.0%), but reoperation rates were similar.
• Patients undergoing resection had more co-morbidities.

Conclusions:

• Laparoscopic lavage is a safe and effective treatment option for perforated diverticulitis with peritonitis in routine clinical practice.
• The procedure offers benefits in reducing complications and hospital stay compared to traditional resection.
• Real-world data supports the use of laparoscopic lavage beyond trial settings.