title: Laparoscopic Lavage for Perforated Diverticulitis With Purulent Peritonitis: A Randomized Trial.
abstract: BACKGROUND
  Perforated diverticulitis with purulent peritonitis has traditionally been treated with open colon resection and stoma formation with risk for reoperations, morbidity, and mortality. Laparoscopic lavage alone has been suggested as definitive treatment.
  
  
  OBJECTIVE
  To compare laparoscopic lavage with open colon resection and colostomy (Hartmann procedure) for perforated diverticulitis with purulent peritonitis.
  
  
  METHODS
  Randomized, controlled, multicenter, open-label trial. (ISRCTN registry number: ISRCTN82208287).
  
  
  METHODS
  9 hospitals in Sweden and Denmark.
  
  
  METHODS
  Patients who have confirmed Hinchey grade III perforated diverticulitis with purulent peritonitis at diagnostic laparoscopy.
  
  
  METHODS
  Randomization between laparoscopic lavage and the Hartmann procedure.
  
  
  METHODS
  Primary outcome was the percentage of patients having 1 or more reoperations within 12 months. Key secondary outcomes were number of reoperations, hospital readmissions, total length of hospital stay during 12 months, and adverse events.
  
  
  RESULTS
  A total of 43 and 40 patients were randomly assigned to laparoscopic lavage and the Hartmann procedure with a median (first, third quartiles) follow-up of 372 days (336, 394) and 378 days (226, 396), respectively. Fewer patients in the laparoscopic group (12 of 43; 27.9%) than in the Hartmann group (25 of 40; 62.5%) had at least 1 reoperation within 12 months (relative risk reduction, 59%; relative risk, 0.41 [95% CI, 0.23 to 0.72]; P = 0.004). Mortality and severe adverse events did not differ between groups. Total length of hospital stay (days) within 12 months was shorter for the laparoscopic group than the Hartmann group, with a reduction of 35% (relative risk, 0.65 [CI, 0.45 to 0.94]; P = 0.047). After 12 months, 3 patients in the laparoscopic group and 11 in the Hartmann group had a stoma.
  
  
  CONCLUSIONS
  Not all patients presenting with suspected diverticulitis were enrolled.
  
  
  CONCLUSIONS
  Laparoscopic lavage reduced the need for reoperations, had a similar safety profile to the Hartmann procedure, and may be an appropriate treatment of choice for acute perforated diverticulitis with purulent peritonitis.
  
  
  BACKGROUND
  ALF; Sahlgrenska University Hospital, Gothenburg.
authors.forename: Anders
authors.initials: A
authors.lastname: Thornell
authors.forename: Eva
authors.initials: E
authors.lastname: Angenete
authors.forename: Thue
authors.initials: T
authors.lastname: Bisgaard
authors.forename: David
authors.initials: D
authors.lastname: Bock
authors.forename: Jakob
authors.initials: J
authors.lastname: Burcharth
authors.forename: Jane
authors.initials: J
authors.lastname: Heath
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Pommergaard
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Stilling
authors.forename: Stefan
authors.initials: S
authors.lastname: Skullman
authors.forename: Eva
authors.initials: E
authors.lastname: Haglind
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects; D003108:Colonic Diseases / Q000150:complications / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects; D004238:Diverticulitis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000601:surgery*; D011788:Quality of Life; D012086:Reoperation; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome