Laparoscopic Lavage Is Feasible and Safe for the Treatment of Perforated Diverticulitis With Purulent Peritonitis: The First Results From the Randomized Controlled Trial DILALA

Eva Angenete, Anders Thornell, Jakob Burcharth, Hans-Christian Pommergaard, Stefan Skullman, Thue Bisgaard, Per Jess, Zoltan Läckberg, Peter Matthiessen, Jane Heath, Jacob Rosenberg, Eva Haglind, Eva Angenete, Anders Thornell, Jakob Burcharth, Hans-Christian Pommergaard, Stefan Skullman, Thue Bisgaard, Per Jess, Zoltan Läckberg, Peter Matthiessen, Jane Heath, Jacob Rosenberg, Eva Haglind

Abstract

Objective: To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial.

Background: Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection and stoma (Hartmann procedure) with considerable postoperative morbidity and mortality. Laparoscopic lavage has been suggested as a less invasive surgical treatment.

Methods: Laparoscopic lavage was compared with colon resection and stoma in a randomized controlled multicenter trial, DILALA (ISRCTN82208287). Initial diagnostic laparoscopy showing Hinchey III was followed by randomization. Clinical data was collected up to 12 weeks postoperatively.

Results: Eighty-three patients were randomized, out of whom 39 patients in laparoscopic lavage and 36 patients in the Hartmann procedure groups were available for analysis. Morbidity and mortality after laparoscopic lavage did not differ when compared with the Hartmann procedure. Laparoscopic lavage resulted in shorter operating time, shorter time in the recovery unit, and shorter hospital stay.

Conclusions: In this trial, laparoscopic lavage as treatment for patients with perforated diverticulitis Hinchey III was feasible and safe in the short-term.

Figures

FIGURE 1
FIGURE 1
Flowchart of patients included in the trial.

References

    1. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg 1978; 12:85–109.
    1. Morris CR, Harvey IM, Stebbings WS, et al. Incidence of perforated diverticulitis and risk factors for death in a UK population. Br J Surg 2008; 95:876–881.
    1. Ince M, Stocchi L, Khomvilai S, et al. Morbidity and mortality of the Hartmann procedure for diverticular disease over 18 years in a single institution. Colorectal Dis 2012; 14:e492–e498.
    1. Thornell A, Angenete E, Haglind E. Perforated diverticulitis operated at Sahlgrenska University Hospital 2003-2008. Dan Med Bull 2011; 58:A4173.
    1. Myers E, Hurley M, O'Sullivan GC, et al. Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 2008; 95:97–101.
    1. Toorenvliet BR, Swank H, Schoones JW, et al. Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a systematic review. Colorectal Dis 2010; 12:862–867.
    1. Alamili M, Gogenur I, Rosenberg J. Acute complicated diverticulitis managed by laparoscopic lavage. Dis Colon Rectum 2009; 52:1345–1349.
    1. Oberkofler CE, Rickenbacher A, Raptis DA, et al. A multicenter randomized clinical trial of primary anastomosis or Hartmann's procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg 2012; 256:819–826.discussion 826–827.
    1. Thornell A, Angenete E, Gonzales E, et al. Treatment of acute diverticulitis laparoscopic lavage vs. resection (DILALA): study protocol for a randomised controlled trial. Trials 2011; 12:186.
    1. Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg 2012; 10:28–55.
    1. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250:187–196.
    1. Swank HA, Vermeulen J, Lange JF, et al. The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitis and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitis in perforated diverticulitis (NTR2037). BMC Surg 2010; 10:29.
    1. Winter DC. LapLAND laparoscopic lavage for acute non-faeculant diverticulitis. Available at: Accessed May 14, 2014.
    1. Öresland T. Scandinavian Diverticulitis Trial (SCANDIV). Available at: Accessed May 14, 2014.
    1. Toorenvliet BR, Swank H, Schoones JW, et al. Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a systematic review. Colorectal Dis 2010; 12:862–867.
    1. Bemelman WA. Laparoscopic peritoneal lavage or resection for generalised peritonitis for perforated diverticulitis (ladies). Available at: Accessed May 14, 2014.
    1. Morris AM, Regenbogen SE, Hardiman KM, et al. Sigmoid diverticulitis: a systematic review. JAMA 2014; 311:287–297.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel