Ahmad Mirza, Simon Galloway. The University Hospital of South Manchester, Manchester, UK
Acute diverticulitis is associated with considerable morbidity and mortality. Management of this pathology has evolved in recent decades. Laparoscopic surgery has added new dimension to the management of this disease and has lead to avoidance of potential open surgery and faecal diversion. We aim to review patients admitted to our hospital with acute diverticulitis and the subsequent laparoscopic management.
We conducted review of all patients who were admitted with acute diverticulitis between 2005 to 2014. We identified patients who had confirmed diagnoses of acutely perforated diverticulitis. We collected the general demographic details, surgical management, pre-operative, intra-operative and post-operative course. We also collected long term patient outcome data.
289 patients were identified who had acute diverticular perforation. All patients had radiological imaging and were classed as Hinchey’s type I (n=96, 33%), II (n=78,27%) , III (n=69, 24%) and IV (n=46, 16%). 64 (22% ) patients proceeded for laparoscopic peritoneal lavage and grouped as Hinchey’s type II (n=16), III (n=48). CT guided drainage was performed in type II (n=36) and type III (n=26) patients. 18 patients who initially had CT guided drainage underwent laparoscopic lavage (n=11) and laparotomy (n=7) at the same admission. The median in-hospital stay for patients undergoing laparoscopic procedure (3 days, range 3 to 11) was significantly better (p=0.04) than CT drainage (6 days, range 5 to 16) and laparotomy (8 days, range 6 to 23). The 30 day morbidity was 19 % (laparoscopy), 32% (CT drainage) and 46% (laparotomy) [p=0.01]. In the first year following the initial procedure, 8 patients were readmitted who underwent initial laparoscopic lavage as compared to 17 re-admissions for patients undergoing CT guided drainage (p=0.03).
Laparoscopic lavage is a promising intervention in the management of acutely perforated diverticular disease. It decreases the need for radical resection and diverting stoma. It also helps in the early recovery and decreased post-operative morbidity.