Laparoscopic peritoneal lavage or primary anastomosis with defunctioning stoma for Hinchey 3 complicated diverticulitis: results of a comparative study.
OBJECTIVE
This study was designed to compare postoperative outcomes of laparoscopic peritoneal lavage and open primary anastomosis with defunctioning stoma in the management of Hinchey 3 diverticulitis.


METHODS
From 1994 to 2006, 35 patients underwent laparoscopic peritoneal lavage for Hinchey 3 diverticulitis in three institutions. Data prospectively collected were compared with those of a retrospective series of 24 patients matched for Hinchey's classification and who underwent primary anastomosis with defunctioning stoma.


RESULTS
There was no postoperative death. Postoperative morbidity was not different between the two groups. One patient in the laparoscopic peritoneal lavage group required a Hartmann's procedure because of a colonic fistula. One patient in the primary anastomosis with defunctioning stoma group underwent a reoperation for incisional dehiscence. The median hospital stay was lower in patients treated by laparoscopic peritoneal lavage (8 vs. 17 days, P < 0.0001). Twenty-five patients in the laparoscopic peritoneal lavage group underwent elective laparoscopic resection. One of them required conversion to laparotomy. All patients in the primary anastomosis with defunctioning stoma group have had their ileostomy closed. Cumulative surgical morbidity (16 vs. 37.5 percent, P = 0.0507) and hospital stay (14 vs. 23 days, P < 0.0001) were lower in the laparoscopic peritoneal lavage group.


CONCLUSIONS
In the management of Hinchey 3 diverticulitis, laparoscopic peritoneal lavage does not result in excess morbidity or mortality, it reduces the length of hospital stay and avoids a stoma in most patients, and it is, therefore, a reasonable alternative to primary anastomosis with defunctioning stoma.
Karoui
Mehdi
M
AP-HP, Department of Digestive and Hepatobiliary Surgery, Henri Mondor University Hospital, Créteil, France. mehdi.karoui@hmn.aphp.fr
Champault
Axèle
A
Pautrat
Karine
K
Valleur
Patrice
P
Cherqui
Daniel
D
Champault
Gérard
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000150:complications / Q000628:therapy*; D004322:Drainage; D005260:Female; D006801:Humans; D007081:Ileostomy; D007416:Intestinal Perforation / Q000150:complications / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage; D012189:Retrospective Studies; D016896:Treatment Outcome