Miguel A Hernandez, MD, Morris E Franklin, MD, FACS, Zanndor Del Real Romo, MD, Guillermo Peralta, MD. Texas Endosurgery Institute.
Background: The most common management for generalized 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 criticized despite further studies including clinical trials have been suggested. The aim of this presentation is to describe the experience with laparoscopic peritoneal lavage and drainage approach in patients with acute diverticulitis.
Methods: A prospective consecutive series database of patients with perforated diverticulitis who underwent emergent LLD was identified. All procedure-related information was collected and analyzed.
Results: A total of 538 patients with acute diverticular disease were analyzed [Female: 290 (54%), Male: 248 (46%), Mean age: 62.8 +/- 15.8, BMI: 29.4 +/- 6.2], 140 patients underwent emergent laparoscopic procedure and 97 were managed by LLD between 1991 and 2013 for acute perforated diverticulitis. Demographic characteristics were analyzed (female: 34; Male: 63), mean age 62.8 +/- 15.8, operative time for 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, hospital length stay (6.6 +/- 2.4 days); 57 of 97 LLD patients underwent an elective sigmoidectomy for the source control.
Conclusions: The LLD can be performed safely and effectively for patients with severe acute diverticulitis with generalized peritonitis. The clinical application of this approach shows acceptable short and long-term outcomes.
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