Introduction The most common management for generalised purulent peritonitis due to perforated diverticulitis is emergency surgical intervention, because it has been associated to life threatening sepsis. For these cases Hartmann’s procedure is recommended as the standard treatment. Laparoscopic approach of peritoneal lavage and drainage (LLD) to treat severe acute diverticulitis has been criticised despite further studies including clinical trials. The aim of this presentation is to describe the experience with laparoscopic peritoneal lavage and drainage approach in patients with acute diverticulitis and generalised peritonitis.
Method A consecutive serie database of patients with perforated diverticulitis who underwent emergent LLD was identified. All procedure-related information was collected and analysed.
Results A total of 538 patients with acute diverticular disease were analysed [Female: 290 (54%), Male: 248 (46%), 140 patients underwent emergent laparoscopic procedure and 97 were managed by LLD between May 1995 and July 2014 for acute perforated diverticulitis. Demographic characteristics were analysed (female: 34; Male: 63), mean age 62.8 +/- 15.8, operative time was 99.7+/- 39.8 min, the estimated blood loss 34.4 +/- 21.2 ml. Three patients were reoperated, two of them to an open Hartmann’s procedure for worsening of septic symptoms during the immediate postoperative period, the other one to repeat the LLD (all of them with faecal peritonitis), hospital length stay (6.6 +/- 2.4 days); 57 of 97 LLD patients underwent an elective surgery for the source control, we had no mortality.
Conclusion The LLD can be performed safely and effectively for patients with severe acute diverticulitis with generalised peritonitis. The clinical application of this approach shows acceptable long-term outcomes.
Disclosure of interest None Declared.
Vermeulen J, Gosselink MP, Hop WCJ, Lange JF, Coene PPLO, Van de Harst E, Weidema WF, Mannaerts GHH. Hospital mortality after emergency surgery for perforated diverticulitis. Ned Tijdschr Geneesk 2009;153:1209–1214
Parks TG. Natural history of diverticular disease of colon. Clin Gastroenterol 1975;4:53–69
Hart A, Kennedy J, Stebbings W. How frequently do large bowel diverticular perforate? An incidence and cross-sectional study. Eur J Gastroenterol Hepatol 2000;12:661–881