title: A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart-Mummery to evidence-based medicine.
abstract: The management of patients with colonic diverticular perforation is still evolving. Initial lavage with or without simple suture and drainage was suggested in the late 19th century, replaced progressively by the three-stage Mayo Clinic or the two-stage Mickulicz procedures. Fears of inadequate source control prompted the implementation of the resection of the affected segment of colon with formation of a colostomy (Hartman procedure) in the 1970's. Ensuing development of the treatment strategies was driven by the recognition of the high morbidity and mortality and low reversal rates associated with the Hartman procedure. This led to the wider use of resection and primary anastomosis during the 1990's. The technique of lavage and drainage regained popularity during the 1990's. This procedure can also be performed laparoscopically with the advantage of faster recovery and shorter hospital stay. This strategy allows resectional surgery to be postponed or avoided altogether in many patients; and higher rates of primary resection and anastomosis can be achieved avoiding the need for a stoma. The three recent randomized controlled trials comparing laparoscopic peritoneal lavage alone to resectional surgery reported inconsistent outcomes. The aim of this review is to review the historical evolution and future reflections of surgical treatment modalities for diffuse purulent and feculent peritonitis. In this review we classified the various surgical strategies according to Krukowski et al. and Vermeulen et al. and reviewed the literature related to surgical treatment separately for each period.
authors.affiliation: Department of General Surgery, University of Perugia, Terni Hospital, Terni, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.affiliation: Department of General Surgery, Cumberland Infirmary, Carlisle, UK.
authors.forename: Sorena
authors.initials: S
authors.lastname: Afshar
authors.affiliation: General (Colorectal) Emergency and Trauma Surgery Service, Maggiore Hospital Regional Emergency Surgery and Trauma Center - Bologna Local Health District, Bologna, Italy.
authors.forename: Salomone
authors.identifier: 0000-0001-5685-5022
authors.initials: S
authors.lastname: Di Saverio
authors.affiliation: Military Medical Academy, Sofia, Bulgaria.
authors.forename: Georgi
authors.initials: G
authors.lastname: Popivanov
authors.affiliation: Department of Surgery, Terni Hospital, Terni, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: De Sol
authors.affiliation: Department of Surgery, University of Ferrara, Ferrara, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gubbiotti
authors.affiliation: General (Colorectal) Emergency and Trauma Surgery Service, Maggiore Hospital Regional Emergency Surgery and Trauma Center - Bologna Local Health District, Bologna, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Tugnoli
authors.affiliation: Department of Surgery, Macerata Hospital, Macerata, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Sartelli
authors.affiliation: Department of Emergency Surgery, Parma Hospital, Parma, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.affiliation: Department of Surgery, Forlì Hospital, Forlì, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Cavaliere
authors.affiliation: Department of Gastrointestinal and General Surgery, Medical University of Wrocław, Wrocław, Poland.
authors.forename: Renata
authors.initials: R
authors.lastname: Taboła
authors.affiliation: Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.|First Department of Surgery, Hippokration University Hospital, University of Athens, Athens, Greece.
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
authors.affiliation: Department of Surgery, E.O. OspedaliGalliera, Genova, Italy.
authors.forename: Gian Andrea
authors.initials: GA
authors.lastname: Binda
mesh_terms: D004239:Diverticulitis, Colonic / Q000150:complications* / Q000601:surgery; D019317:Evidence-Based Medicine / Q000379:methods; D013502:General Surgery / Q000266:history*; D049673:History, 20th Century; D006801:Humans; D010538:Peritonitis / Q000209:etiology / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000266:history / Q000379:methods
keywords: Acute care surgery; Acute diverticulitis; Colorectal surgery; Emergency surgery; Hartmann resection; Laparoscopic lavage; Perforated diverticulitis