Five years of experience with laparoscopic peritoneal lavage as the first line of management for perforated colonic diverticulitis with purulent peritonitis

Background
Emergency colonic resection with anastomosis or Hartmann's procedure (with colostomy) is the traditional management of acute diverticulitis complicated by perforation. Recently, promising results have been reported after laparoscopic lavage in these cases. Selection of patients for this technique is of great importance. This study presents our early experience in the management of purulent peritonitis (Hinchey III) due to perforated diverticulitis.
Patients and methods
A prospective study of 80 patients was conducted during the period between January 2010 and January 2015. All patients with purulent peritonitis (Hinchey III) underwent a trial of laparoscopic peritoneal lavage and drainage. The degree of peritonitis and the procedure-related information were recorded. The primary endpoint of this study was mortality and major morbidity within 30 days of operation. The secondary endpoint included readmission, postoperative complications, length of hospital stay, reoperation, and mortality within 12 months of the emergency surgery.
Results
A total of 87 patients were treated with laparoscopic peritoneal lavage. Seven patients had fecal peritonitis (Hinchey IV) and were excluded from the study. The other 80 patients with a mean age of 55 years were included in the study; four of them (5%) had Hinchey II disease and 76 (95%) had Hinchey III disease. The mean operative time was 100 min. The overall morbidity was 15% and mortality rate was 5%. There were five early reinterventions because of treatment failure. The mean length of hospital stay was 10 days. There was no recurrence of diverticulitis and no intervention was performed after a median follow-up period of 48 months (range = 12–60 months).
Conclusion
Laparoscopic peritoneal lavage and drainage, for diffuse purulent peritonitis due to perforated diverticulitis, is safe and effective. Using this technique, emergency laparotomy with risk for colostomy can be avoided.