Laparoscopic lavage is superior to colon resection for perforated purulent diverticulitis: a meta-analysis
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Laparoscopic lavage is superior to colon resection for perforated purulent diverticulitis : a meta-analysis. / Angenete, Eva; Bock, David; Rosenberg, Jacob; Haglind, Eva.
In: International Journal of Colorectal Disease, Vol. 32, No. 2, 02.2017, p. 163-169.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Laparoscopic lavage is superior to colon resection for perforated purulent diverticulitis
T2 - a meta-analysis
AU - Angenete, Eva
AU - Bock, David
AU - Rosenberg, Jacob
AU - Haglind, Eva
PY - 2017/2
Y1 - 2017/2
N2 - PURPOSE: Perforated diverticulitis often requires surgery with a colon resection such as Hartmann's procedure, with inherent morbidity. Recent studies suggest that laparoscopic lavage may be an alternative surgical treatment. The aim of this study was to compare re-operations, morbidity, and mortality as well as health economic outcomes between laparoscopic lavage and colon resection for perforated purulent diverticulitis.METHODS: PubMed, Cochrane, Centre for Reviews and Dissemination, and Embase were searched. Published randomized controlled trials and prospective and retrospective cohorts with laparoscopic lavage and colon resection as interventions were identified. Trial limitations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Re-operations, complications at 90 days classified according to Clavien-Dindo and mortality were extracted.RESULTS: Three randomized trials published between 2005 and 2015 were included in the analysis. The studies included a total of 358 patients with 185 patients undergoing laparoscopic lavage. At 12 months, the relative risk of having a re-operation was lower for laparoscopic lavage compared to colon resection in the two trials that had a 12 month follow-up. We found no significant differences in Clavien-Dindo complications classified more than level IIIB or mortality at 90 days.CONCLUSIONS: The risk for re-operations within the first 12 months after index surgery was lower for laparoscopic lavage compared to colon resection, with overall comparable morbidity and mortality. Furthermore, Hartmann's resection was more costly than laparoscopic lavage. We therefore consider laparoscopic lavage a valid alternative to surgery with resection for perforated purulent diverticulitis.
AB - PURPOSE: Perforated diverticulitis often requires surgery with a colon resection such as Hartmann's procedure, with inherent morbidity. Recent studies suggest that laparoscopic lavage may be an alternative surgical treatment. The aim of this study was to compare re-operations, morbidity, and mortality as well as health economic outcomes between laparoscopic lavage and colon resection for perforated purulent diverticulitis.METHODS: PubMed, Cochrane, Centre for Reviews and Dissemination, and Embase were searched. Published randomized controlled trials and prospective and retrospective cohorts with laparoscopic lavage and colon resection as interventions were identified. Trial limitations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Re-operations, complications at 90 days classified according to Clavien-Dindo and mortality were extracted.RESULTS: Three randomized trials published between 2005 and 2015 were included in the analysis. The studies included a total of 358 patients with 185 patients undergoing laparoscopic lavage. At 12 months, the relative risk of having a re-operation was lower for laparoscopic lavage compared to colon resection in the two trials that had a 12 month follow-up. We found no significant differences in Clavien-Dindo complications classified more than level IIIB or mortality at 90 days.CONCLUSIONS: The risk for re-operations within the first 12 months after index surgery was lower for laparoscopic lavage compared to colon resection, with overall comparable morbidity and mortality. Furthermore, Hartmann's resection was more costly than laparoscopic lavage. We therefore consider laparoscopic lavage a valid alternative to surgery with resection for perforated purulent diverticulitis.
KW - Aged
KW - Colon
KW - Demography
KW - Diverticulitis
KW - Female
KW - Humans
KW - Intestinal Perforation
KW - Laparoscopy
KW - Male
KW - Middle Aged
KW - Peritoneal Lavage
KW - Postoperative Complications
KW - Reoperation
KW - Journal Article
KW - Meta-Analysis
KW - Review
U2 - 10.1007/s00384-016-2636-0
DO - 10.1007/s00384-016-2636-0
M3 - Review
C2 - 27567926
VL - 32
SP - 163
EP - 169
JO - International Journal of Colorectal Disease
JF - International Journal of Colorectal Disease
SN - 0179-1958
IS - 2
ER -
ID: 180399669