Laparoscopic lavage is superior to colon resection for perforated purulent diverticulitis-a meta-analysis

Eva Angenete, David Bock, Jacob Rosenberg, Eva Haglind, Eva Angenete, David Bock, Jacob Rosenberg, Eva Haglind

Abstract

Purpose: Perforated diverticulitis often requires surgery with a colon resection such as Hartmann's procedure, with inherent morbidity. Recent studies suggest that laparoscopic lavage may be an alternative surgical treatment. The aim of this study was to compare re-operations, morbidity, and mortality as well as health economic outcomes between laparoscopic lavage and colon resection for perforated purulent diverticulitis.

Methods: PubMed, Cochrane, Centre for Reviews and Dissemination, and Embase were searched. Published randomized controlled trials and prospective and retrospective cohorts with laparoscopic lavage and colon resection as interventions were identified. Trial limitations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Re-operations, complications at 90 days classified according to Clavien-Dindo and mortality were extracted.

Results: Three randomized trials published between 2005 and 2015 were included in the analysis. The studies included a total of 358 patients with 185 patients undergoing laparoscopic lavage. At 12 months, the relative risk of having a re-operation was lower for laparoscopic lavage compared to colon resection in the two trials that had a 12 month follow-up. We found no significant differences in Clavien-Dindo complications classified more than level IIIB or mortality at 90 days.

Conclusions: The risk for re-operations within the first 12 months after index surgery was lower for laparoscopic lavage compared to colon resection, with overall comparable morbidity and mortality. Furthermore, Hartmann's resection was more costly than laparoscopic lavage. We therefore consider laparoscopic lavage a valid alternative to surgery with resection for perforated purulent diverticulitis.

Keywords: Diverticulitis; Laparoscopy; Morbidity.

Conflict of interest statement

Compliance with ethical standards Funding This research was supported by Sahlgrenska University Hospital (the agreement concerning research and education of doctors) and the Swedish Research Council (2012–1770). Conflict of interest The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA diagram showing selection of articles for review
Fig. 2
Fig. 2
Forest plot comparing the effects of the two surgical techniques on re-operations, complications (according to Clavien-Dindo), and mortality. From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. doi:10.1371/journal.pmed1000097. For more information, visit www.prisma-statement.org

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Source: PubMed

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