Purulent diverticulitis: laparoscopic lavage vs colonic resection

  • Pan Z & al.
  • Int J Surg
  • 11 Oct 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with purulent perforated acute diverticulitis, laparoscopic lavage (LL) vs colonic resection (CR) provides similar mortality, shorter operative time and hospital stay.
  • However, evidence suggests that LL might be inadequate for sepsis control and result in more unplanned reoperations.

Why this matters

  • Findings do not support that LV is superior to a traditional CR and may not be recommended as a safer alternative in the management of purulent perforated acute diverticulitis

Study design

  • Systematic review and meta-analysis of 11 studies including a total of 569 patients with diverticulitis (HincheyⅢ >80%).
  • Funding: None.

Key results

  • Overall, 276 patients received LL and 283 underwent CR.
  • The LL vs CR group was associated with significantly shorter:
    • operative time (weighted mean difference [WMD];  −78.85; 95% CI, -100.58  to -57.11; P<.0001 and>
    • length of hospital stays (WMD, −7.62; 95% CI, -11.60  to -3.63; P=.0002).
  • However, the LL group reported higher rates of intra-abdominal abscess (OR, 2.69; 95% CI, 1.39-5.21; P=.0032) and secondary peritonitis (OR, 5.30; 95% CI, 1.91 -14.73; P=.0014).
  • The LL vs CR group reported more reoperations within 90 days but no significant difference at 12 months (stoma reversal included; OR, 2.52; P=.028).
  • The risk for reoperations was not significantly different in sub-group analysis (3 randomised controlled trials).

Limitations

  • Heterogeneity among included studies.
  • Lack of individual patient data.