Less Is (Sometimes) More: Laparoscopic Peritoneal Lavage and Drainage for Diverticulitis

Area of Science:

• Gastroenterology
• Surgical Innovation
• Clinical Outcomes Research

Background:

• Diverticulitis with uncontained perforation presents a surgical challenge.
• Hartmann's procedure (HP) is a traditional treatment, while Laparoscopic lavage and drainage (LLD) offers a less invasive alternative.
• The efficacy and indications for LLD in modern practice require further clarification.

Purpose of the Study:

• To review the literature on Laparoscopic lavage and drainage (LLD) for diverticulitis with uncontained perforation.
• To analyze techniques, outcomes, and indications for LLD.
• To compare LLD with traditional surgical approaches like Hartmann's procedure (HP) and resection with anastomosis.

Main Methods:

• Systematic review of case studies, randomized trials, prospective series, retrospective analyses, and meta-analyses.
• Focus on studies comparing LLD with HP or resection and anastomosis for diverticulitis (Hinchey I-III).
• Analysis of clinical outcomes including morbidity, mortality, and reoperation rates.

Main Results:

• LLD may be considered for Hinchey III diverticulitis (purulent peritonitis) with contraindications.
• Randomized trials (LADIES, SCANDIV, DILALA) show varied outcomes: LADIES reported higher initial morbidity for LLD, SCANDIV noted higher reoperation rates, and DILALA found lower reoperation rates for LLD.
• Debate continues regarding optimal LLD technique, specific indications, and long-term outcomes compared to resection or HP.

Conclusions:

• Laparoscopic lavage and drainage (LLD) is a potential option for select cases of perforated diverticulitis (Hinchey III).
• Current evidence from randomized controlled trials presents conflicting data on LLD's superiority over resection or Hartmann's procedure.
• Further research and standardized techniques are needed to define the precise role of LLD in managing complicated diverticulitis.