Sharique Nazir, MD, Aaron Lee, DO, Laurence Diggs, BA, Alex Bulanov, MS, Michael Timoney, MD, FACS, George Ferzli, MD, FACS. Lutheran medical center
The aim of this study was to evaluate the results of the laparoscopic aspiration and drainage in the management of complicated diverticulitis not amenable to IR drainage from 2012-2014. We wanted to assess its potential as an alternative to open surgery and diverting ostomy.
The management of this condition has greatly evolved since the introduction of laparoscopic peritoneal lavage in 1996. This less invasive option has become increasingly popular but the standard of care for Hinchey III diverticulitis remains a resection with diversion. Yet for cases where feculant material is not found in the peritoneum, peritoneal lavage is being described as a suitable bridging procedure to reduce the morbidity and mortality associated with performing colectomy with diversion.
We are interested in evaluating the effectiveness of the aspiration of purulent material and the placement of drains instead of aggressive lavage of the entire abdominal cavity. Our hypothesis is that lavage of the entire abdomen has a potential risk of bacterial seeding, and the aspiration would minimize the risk with equal benefit.
We performed a retrospective chart review of all patients who went to the operating room with a diagnosis of complicated diverticulitis. We excluded all patients who had Hinchey IV, all patients who underwent intraoperative washout and all those who had a colectomy. Five patients fit our criteria. They underwent laparoscopic peritoneal aspiration for Hinchey III diverticulitis. Data recorded included demographics, operative details, length of hospital stay, complications, and the incidence of interval colectomy. Primary endpoints were operative success, resolution of symptoms and the avoidance of colostomy.
The steps involved in the procedure is accessing the peritoneal cavity, placement of two 5 mm ports and 10 mm port for a 30 degree camera, lysing of inflammatory tissue causing adhesions, thorough laparoscopic inspection of the abdomen, localization with aspiration of the collection and placement of 2 closed suction drains exiting from 5 mm port site.
Of the 5 patients selected, 3 were male and 2 were female. The average age was 57.2 years. 2 patients were Caucasian and 3 were mixed race. The average operative time was 59.6 minutes and the average hospital length of stay was 3.8 days. One patient presented on post-operative day 8 with abdominal pain and a residual abscess which was treated with 3 days of IV antibiotics. All surgeries were successful in managing the acute exacerbation of Hinchey III diverticulitis. 2 patients eventually had interval colectomies.
At our center we successfully performed 5 laparoscopic aspirations with drain placement in patients for whom peritoneal lavage would otherwise have been considered as an alternative to colectomy. We saw no complications related to the laparoscopic technique in our study. We propose that in a carefully selected population, it is worth examining whether aspiration has equivalent outcomes to lavage in cases where IR drainage is not possible.