TY - JOUR

T1 - Laparoscopic Lavage Is Feasible and Safe for the Treatment of Perforated Diverticulitis With Purulent Peritonitis

T2 - The First Results From the Randomized Controlled Trial DILALA

AU - Angenete, Eva

AU - Thornell, Anders

AU - Burcharth, Jakob

AU - Pommergaard, Hans-Christian

AU - Skullman, Stefan

AU - Bisgaard, Thue

AU - Jess, Per

AU - Läckberg, Zoltan

AU - Matthiessen, Peter

AU - Heath, Jane

AU - Rosenberg, Jacob

AU - Haglind, Eva

PY - 2016/1

Y1 - 2016/1

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Colonic Diseases

KW - Diverticulitis

KW - Feasibility Studies

KW - Female

KW - Humans

KW - Intestinal Perforation

KW - Laparoscopy

KW - Male

KW - Middle Aged

KW - Peritonitis

KW - Prospective Studies

KW - Suppuration

KW - Therapeutic Irrigation

KW - Young Adult

U2 - 10.1097/SLA.0000000000001061

DO - 10.1097/SLA.0000000000001061

M3 - Journal article

C2 - 25489672

VL - 263

SP - 117

EP - 122

JO - Advances in Surgery

JF - Advances in Surgery

SN - 0003-4932

IS - 1

ER -