title: Laparoscopic lavage for perforated diverticulitis:  a population analysis.
abstract: BACKGROUND
  Laparoscopic lavage has shown promising results in nonfeculent perforated diverticulitis. It is an appealing strategy; it avoids the complications associated with resection. However, there has been some reluctance to widespread uptake because of the scarcity of large-scale studies.
  
  
  OBJECTIVE
  This study investigated national trends in management of perforated diverticulitis.
  
  
  METHODS
  This retrospective population study used an Irish national database to identify patients acutely admitted with diverticulitis, as defined by the International Classification of Diseases. Demographics, procedures, comorbidities, and outcomes were obtained for the years 1995 to 2008.
  
  
  METHODS
  The study was conducted in Ireland.
  
  
  METHODS
  Patients with International Classification of Diseases codes corresponding to diverticulitis who underwent operative intervention were included.
  
  
  METHODS
  The primary outcome was mortality, and secondary outcomes were length of stay and postoperative complications.
  
  
  RESULTS
  Two thousand four hundred fifty-five patients underwent surgery for diverticulitis, of whom 427 underwent laparoscopic lavage. Patients selected for laparoscopic lavage had lower mortality (4.0% vs 10.4%, p < 0.001), complications (14.1% vs 25.0%, p < 0.001), and length of stay (10 days vs 20 days, p < 0.001) than those requiring laparotomy/resection. Patients older than 65 years were more likely to die (OR 4.1, p < 0.001), as were those with connective tissue disease (OR 7.3, p < 0.05) or chronic kidney disease (OR 8.0, p < 0.001).
  
  
  CONCLUSIONS
  This retrospective study is limited by the quality of data obtained and is subject to selection bias. Furthermore, the lack of disease stratification means it is not possible to identify the extent of peritonitis; feculent peritonitis has worse outcomes and is not likely to be included in the lavage group.
  
  
  CONCLUSIONS
  The number of patients selected for laparoscopic lavage in perforated diverticulitis is increasing, and the outcomes in this study are comparable to other reports. Those patients in whom laparoscopic lavage alone was suitable had lower mortality and morbidity than those in whom resection was considered necessary.
authors.affiliation: Institute for Clinical Outcomes Research & Education and Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
authors.forename: Ailín C
authors.initials: AC
authors.lastname: Rogers
authors.forename: Danielle
authors.initials: D
authors.lastname: Collins
authors.forename: Gerald C
authors.initials: GC
authors.lastname: O'Sullivan
authors.forename: Desmond C
authors.initials: DC
authors.lastname: Winter
mesh_terms: D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage / Q000379:methods*; D012189:Retrospective Studies