[Conservative laparoscopic treatment of diverticular peritonitis].
OBJECTIVE
To evaluate the results of a strategy of conservative laparoscopic treatment of peritonitis due to perforated diverticulitis for all patients, without exception for intraoperative findings or general patient condition, and to study the feasibility of eventual second-stage laparoscopic colectomy.


METHODS
Between January 2003 and May 2007, 25 consecutive patients were urgently hospitalized with acute peritonitis due to perforated diverticulitis. All patients underwent laparoscopic peritoneal lavage and debridement; when there was a large perforation (ten cases), suture closure under laparoscopic control was performed. The Hinchey classification of peritonitis was Stage I in 2, Stage IIB in 8, Stage III in 9, and Stage IV in 6.


RESULTS
Postoperative morbidity occurred in 12% of cases. Mean operative time was 71 minutes. Conversion to open laparotomy was not required. Complications included residual abscess (drained percutaneously with CT guidance), urinary tract infection, and prolonged drainage via the drain tract. Mortality was zero. Mean hospital stay was 13.8 days. Sixteen patients (64%) subsequently underwent laparoscopic colectomy as a second stage procedure.


CONCLUSIONS
Conservative laparoscopic treatment of acute peritonitis due to perforated diverticulitis is a reliable alternative to open laparotomy in many cases; eventual laparoscopic colectomy at a subsequent stage is possible in the majority of patients.
Mazza
D
D
Service de chirurgie viscérale, centre hospitalier de Toulon, 1208, boulevard du colonel Picot, 83056 Toulon, France. mazza.davide@free.fr
Chio'
F
F
Khoury-Helou
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004240:Diverticulum / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010532:Peritoneal Diseases / Q000150:complications / Q000601:surgery; D010538:Peritonitis / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult