Laparoscopic lavage and drainage in the management of acute diverticulitis: Is it time to move on?

Česká verzia

Authors: P. Zonča; P. Ihnát; M. Peteja ; P. Guňková; P. Vávra; L. Martínek
Authors place of work: Chirurgická klinika, FN a LF Ostrava, přednosta: Doc. MUDr. P. Zonča, PhD., FRCS
Published in the journal: Rozhl. Chir., 2013, roč. 92, č. 11, s. 634-639.
Category: Original articles

Summary

Introduction:
Diverticular disease management represents a very topical issue with many unanswered questions as yet. Laparoscopic lavage and drainage in patients with acute diverticulitis is one of the controversial areas. Miniinvasive approach presents a possible treatment alternative for CT– guided percutaneous drainage and also for radical colon resection in the form of Hartmann’s procedure or resection with primary anastomosis.

Material a methods:
The authors’ aim was the evaluation of patients with Hinchey II, III or IV diverticulitis treated by laparoscopic lavage and drainage, or by laparoscopic suture of the perforation, in a retrospective cohort study. The inclusion criterion for the study was laparoscopic lavage and drainage indication in patients with Hinchey II, III or IV diverticulitis. The primary aim of the study was laparoscopic treatment evaluation focused on leakage, if applicable, and on postoperative morbidity and mortality.

Results:
During the study period (2007–2012), 12 patients operated on at our department (with a mean age of 71.7 years) were included into the study. The group comprised 7 men and 5 women with a BMI of 28.1 kg/m². Laparoscopic exploration, lavage and drainage of the abdominal cavity with purulent peritonitis finding were performed in 10 patients. The site of bowel perforation was not located unambiguously in these patients. Two patients with faecal peritonitis and identified place of perforation underwent laparoscopic lavage, drainage and suture of the perforation. Postoperative leakage was not detected in any of the patients. The mean operating time was 65 minutes, postoperative morbidity reaching 27.7%, and postoperative mortality 0%. The mean length of hospital stay was 8.8 days. Elective laparoscopic resection was performed 6–15 weeks after the primary operation in 8 patients.

Conclusion:
Laparoscopic exploration with thorough lavage, suture of the perforation and drainage presents a possible alternative in modern management of acute diverticulitis. The miniinvasive approach indication should be based both on careful, highly individualised and complex patient evaluation and on the department’s experience.

Key words:
diverticular disease – acute diverticulitis – laparoscopic drainage – miniinvasive surgery – damage control surgery

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