title: Laparoscopic Lavage in the Management of Hinchey Grade III Diverticulitis: A Systematic Review.
abstract: OBJECTIVE
  To compare the outcomes of laparoscopic lavage and sigmoid resection in perforated diverticulitis with purulent peritonitis.
  
  
  BACKGROUND
  Peritonitis secondary to perforated diverticulitis has conventionally been managed by resection and stoma formation. Case series have suggested that patients can be safely managed with laparoscopic lavage, resulting in reduced mortality and stoma formation. Recently, 3 randomized controlled trials have published contradictory conclusions.
  
  
  METHODS
  MEDLINE from 1946 to present, Cochrane Database of Systematic Reviews, and Cochrane database of Registered clinical trials and EMBASE (all via OVID) were searched using the terms "laparoscopy" AND ("primary resection" OR "Hartmann procedure", OR "sigmoidectomy"), AND "Diverticulitis", AND "Peritonitis" AND "therapeutic irrigation" or "lavage" AND randomized controlled trial and any derivatives of those terms. We included all randomized controlled trials. Data were extracted from each study using a purpose-designed template. Statistical analysis was undertaken using Revman 5.
  
  
  RESULTS
  Three randomized controlled trials were identified from 48 potential studies. The analysis included 307 patients of whom 159 underwent laparoscopic lavage. Overall, the rate of reintervention within 30 days postoperatively was 45/159 (28.3%) in the lavage group and 13/148 (8.8%) in the resection group (relative risk 3.01, 95% confidence interval 1.15-7.90). There was no significant difference in Intensive Care Unit admissions, 30 and 90-day mortality, or stoma rates at 12 months.
  
  
  CONCLUSIONS
  Laparoscopic lavage used in the management of Hinchey grade III diverticulitis leads to more reinterventions within 30 days postoperatively, but does not increase the 30 or 90-day mortality rates compared with sigmoid resection.
authors.affiliation: *Department of Surgery, Christchurch Hospital, Christchurch, New Zealand †University of Otago, Christchurch, New Zealand ‡Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway §Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: James R
authors.initials: JR
authors.lastname: Marshall
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Buchwald
authors.forename: Jamish
authors.initials: J
authors.lastname: Gandhi
authors.forename: Johannes K
authors.initials: JK
authors.lastname: Schultz
authors.forename: Phil N
authors.initials: PN
authors.lastname: Hider
authors.forename: Frank A
authors.initials: FA
authors.lastname: Frizelle
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Eglinton
mesh_terms: D004238:Diverticulitis / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D004241:Diverticulum, Colon / Q000150:complications; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D008297:Male; D010533:Peritoneal Lavage / Q000379:methods* / Q000401:mortality; D010538:Peritonitis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome