title: Laparoscopic lavage is superior to colon resection for perforated purulent diverticulitis-a meta-analysis.
abstract: OBJECTIVE
  Perforated diverticulitis often requires surgery with a colon resection such as Hartmann's procedure, with inherent morbidity. Recent studies suggest that laparoscopic lavage may be an alternative surgical treatment. The aim of this study was to compare re-operations, morbidity, and mortality as well as health economic outcomes between laparoscopic lavage and colon resection for perforated purulent diverticulitis.
  
  
  METHODS
  PubMed, Cochrane, Centre for Reviews and Dissemination, and Embase were searched. Published randomized controlled trials and prospective and retrospective cohorts with laparoscopic lavage and colon resection as interventions were identified. Trial limitations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Re-operations, complications at 90 days classified according to Clavien-Dindo and mortality were extracted.
  
  
  RESULTS
  Three randomized trials published between 2005 and 2015 were included in the analysis. The studies included a total of 358 patients with 185 patients undergoing laparoscopic lavage. At 12 months, the relative risk of having a re-operation was lower for laparoscopic lavage compared to colon resection in the two trials that had a 12 month follow-up. We found no significant differences in Clavien-Dindo complications classified more than level IIIB or mortality at 90 days.
  
  
  CONCLUSIONS
  The risk for re-operations within the first 12 months after index surgery was lower for laparoscopic lavage compared to colon resection, with overall comparable morbidity and mortality. Furthermore, Hartmann's resection was more costly than laparoscopic lavage. We therefore consider laparoscopic lavage a valid alternative to surgery with resection for perforated purulent diverticulitis.
authors: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, SE-416 85, Gothenburg, Sweden. eva.angenete@vgregion.se.
authors: Eva
authors: http://orcid.org/0000-0001-9966-4904
authors: E
authors: Angenete
authors: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, SE-416 85, Gothenburg, Sweden.
authors: David
authors: D
authors: Bock
authors: Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730, Herlev, Denmark.
authors: Jacob
authors: J
authors: Rosenberg
authors: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, SE-416 85, Gothenburg, Sweden.
authors: Eva
authors: E
authors: Haglind
mesh_terms: D000368:Aged; D003106:Colon / Q000601:surgery*; D003710:Demography; D004238:Diverticulitis / Q000601:surgery*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation
keywords: Diverticulitis; Laparoscopy; Morbidity