Five years of experience with laparoscopic peritoneal lavage as the first line of management for perforated colonic diverticulitis with purulent peritonitis

Severe stages of acute, colonic diverticulitis can progress into intestinal perforations with peritonitis. In such cases, urgent treatment is needed, and Hartmann’s procedure is the standard treatment for cases with fecal peritonitis. Peritoneal lavage may be an alternative to resection for acute diverticulitis with purulent peritonitis, but ongoing randomized trials are awaited to clarify this.

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What is the role of laparoscopic peritoneal lavage for perforated diverticulitis with purulent peritonitis in 2016?

Journal of Visceral Surgery ◽

10.1016/j.jviscsurg.2016.04.004 ◽

2016 ◽

Vol 153 (3) ◽

pp. 159-160 ◽

Cited By ~ 3

Author(s):

S. Benoist

Keyword(s):

Peritoneal Lavage ◽

Perforated Diverticulitis ◽

Laparoscopic Peritoneal Lavage ◽

Purulent Peritonitis

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Laparoscopic Lavage in the Management of Hinchey III/IV Diverticulitis

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0040-1716702 ◽

2021 ◽

Vol 34 (02) ◽

pp. 104-112

Author(s):

Maria X. Kiely ◽

Mengdi Yao ◽

Lilian Chen

Keyword(s):

Peritoneal Lavage ◽

Mortality Rates ◽

Perforated Diverticulitis ◽

Local Inflammation ◽

Major Morbidity ◽

Laparoscopic Lavage ◽

Laparoscopic Peritoneal Lavage ◽

Purulent Peritonitis ◽

Bowel Continuity ◽

Emergency Resection

AbstractDiverticulitis manifestations may cover a spectrum of mild local inflammation to diffuse feculent peritonitis. Up to 35% of patients presenting with diverticulitis will have purulent (Hinchey grade III) or feculent (Hinchey grade IV) contamination of the abdomen, with a high-associated morbidity and mortality. Surgical management may involve segmental resection with or without restoration of bowel continuity. However, emergency resection for diverticulitis can be associated with high mortality rates, as well as low stoma reversal rates at 1 year. Therefore, laparoscopic peritoneal lavage has been proposed for use in selected patients with purulent peritonitis. The topic of laparoscopic peritoneal lavage for the treatment of perforated diverticulitis in the literature has been controversial. Our review of the recent data show that laparoscopic lavage may be safe and feasible in select patients with similar rates of mortality and major morbidity. There is, however, a concern regarding an associated higher rate of postoperative abscess and early reintervention risk.

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LAPAROSCOPIC PERITONEAL LAVAGE IN TREATMENT OF PURULENT AND FECAL PERITONITIS AS COMPLICATIONS OF THE COLONIC DIVERTICULAR DISEASE

Kharkiv Surgical School ◽

10.37699/2308-7005.1.2020.05 ◽

2020 ◽

pp. 51-53

Author(s):

M. A. Kashtalian ◽

O. B. Tymchuk ◽

I. P. Kurachenko

Keyword(s):

Peritoneal Lavage ◽

Bowel Resection ◽

Primary Anastomosis ◽

Laparoscopic Approach ◽

Perforated Diverticulitis ◽

Early Recovery ◽

Research Results ◽

Laparoscopic Peritoneal Lavage ◽

Purulent Peritonitis ◽

Colonic Diverticular Disease

Summary. The incidence of diverticular colon disease has increased significantly. Complications are found in 40-42 % of patients, the frequency of perforation of the diverticulum is about 3.3 %. Materials and methods. The article presents the results of the treatment of 129 patients who were operated on for peritonitis complicated forms of diverticular colon disease . Research results. The study found that surgical treatment of patients with complication in the Hinchey III-IV stage is best performed by the method of laparoscopic peritoneal lavage. Discussion of research results. The laparoscopic approach has demonstrated a number of advantages: a smaller wound size, a shorter period of disability, an early recovery of enteral nutrition, and a shorter hospital stay. Conclusions. Performing laparoscopic peritoneal lavage in patients with perforated diverticulitis complicated by purulent peritonitis is an alternative to Hartmann surgery or bowel resection with primary anastomosis.

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Early Experience with Laparoscopic Lavage in Acute Complicated Diverticulitis

Digestive Surgery ◽

10.1159/000375539 ◽

2015 ◽

Vol 32 (2) ◽

pp. 108-111 ◽

Cited By ~ 5

Author(s):

Nir Horesh ◽

Andrew P. Zbar ◽

Avinoam Nevler ◽

Nadav Haim ◽

Mordechai Gutman ◽

...

Keyword(s):

Peritoneal Lavage ◽

Acute Diverticulitis ◽

Complicated Diverticulitis ◽

Elective Resection ◽

Symptomatic Disease ◽

Recurrent Diverticulitis ◽

Laparoscopic Peritoneal Lavage ◽

Purulent Peritonitis ◽

Long Term Follow Up ◽

Feasible Option

Background: Contemporary surgical management of complicated diverticulitis is controversial. Traditionally, the gold standard has been resection and colostomy, but recently peritoneal lavage and drainage without resection in cases of purulent peritonitis have been suggested. This study aims to review our initial experience with laparoscopic peritoneal lavage for complicated diverticulitis. Methods: Retrospective review of all patients who underwent emergent peritoneal lavage and drainage for acute complicated diverticulitis. Results: Five-hundred-thirty-eight patients admitted for acute diverticulitis between 2007 and 2012 were recorded in the database. Thirty seven underwent emergent surgery of which 10 had peritoneal lavage and drainage without colonic resection for complicated diverticulitis causing peritonitis. Peritoneal lavage and drainage resulted in the resolution of acute symptoms in all cases. In long-term follow-up, 3 (30%) patients required elective resection owing to symptomatic disease, two of these due to recurrent diverticulitis, and one owing to complicated fistula following the procedure. Conclusion: Peritoneal lavage is a feasible option for complicated diverticulitis with purulent non-fecal peritonitis, but a significant portion of the patients may require elective resection. Comparative studies with emergent resection are needed to determine the role of peritoneal lavage in complicated diverticulitis.

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