Two-stage totally minimally invasive approach for acute complicated diverticulitis.
OBJECTIVE
Surgical options for acute diverticulitis with peritonitis include Hartmann's procedure or resection and primary anastomosis with or without a stoma. Initial laparoscopic lavage and drainage can control the acute intra-abdominal sepsis to allow for a delayed definitive procedure in nonemergency conditions. Potential advantages include the avoidance of a laparotomy, stoma and local infections at the origin of dehiscence and incisional hernias. We evaluated this approach in a selected group of patients.


METHODS
Patients with intra-abdominal pus secondary to diverticular perforation requiring surgery were included in the study. Patients with localized pus amenable to computerized tomography (CT)-guided drainage, faecal peritonitis, severe generalized peritonitis, and those in which the perforation was spontaneously visible were excluded. Standard demographic data, CT findings, intra-operative findings and postoperative outcomes were analysed.


RESULTS
Ten patients were suitable for the approach. Mean patient age was 60.2 years. Mean body mass index was 28.2 m2/kg. Mean postoperative stay was 8.5 days and uneventful in all patients. One patient re-presented after 3 weeks with acute peritonitis requiring open sigmoidectomy. Six patients successfully underwent laparoscopic sigmoidectomy with primary anastomosis 2-3 months later. Two patients were not re-operated because of comorbidity and one refused surgery.


CONCLUSIONS
A two-stage totally minimally invasive approach may be a safe alternative strategy for selected cases of acute complicated diverticulitis.
Mutter
D
D
IRCAD, University of Strasbourg, Strasbourg, France.
Bouras
G
G
Forgione
A
A
Vix
M
M
Leroy
J
J
Marescaux
J
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D004322:Drainage; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D007507:Therapeutic Irrigation