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Emergency laparoscopic management of perforated sigmoid diverticulitis: a promising alternative to more radical procedures.
J Am Coll Surg. 2008 Apr; 206(4):654-7.JA

Abstract

BACKGROUND

Classic emergency surgical management of complicated perforated sigmoid diverticulitis is based on the principle of a two-stage operation, with colon resection and temporary stoma (Hartmann's procedure). But the later second-stage operation can be technically difficult and can be associated with a significant morbidity rate. We argue that laparoscopy may be beneficial in such patients with peritonitis in terms of operative results and could facilitate later surgical management.

STUDY DESIGN

We studied all consecutive patients with perforated sigmoid diverticulitis requiring emergency surgery between January 2000 and December 2004.

RESULTS

Twenty-four patients underwent emergency laparoscopic management for perforated sigmoid diverticulitis. Nineteen patients (80%) were found to have a purulent or fecal diffuse peritonitis. No conversion and colostomy were necessary. The overall morbidity rate was 8%; 2 patients with pelvic abscesses required radiologic drainage. The median hospital stay was 12 days (range 7 to 35 days). Prophylactic sigmoid resection was performed by laparoscopy in all patients, with a conversion rate of 16%.

CONCLUSIONS

Laparoscopic treatment of generalized peritonitis secondary to diverticulitis is feasible and safe and may be a promising alternative to more radical surgery in selected patients, avoiding fecal diversion and allowing a delayed elective laparoscopic sigmoid resection.

Authors+Show Affiliations

Department of Digestive Surgery, Trousseau Hospital, Tours, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18387470

Citation

Bretagnol, Frederic, et al. "Emergency Laparoscopic Management of Perforated Sigmoid Diverticulitis: a Promising Alternative to More Radical Procedures." Journal of the American College of Surgeons, vol. 206, no. 4, 2008, pp. 654-7.
Bretagnol F, Pautrat K, Mor C, et al. Emergency laparoscopic management of perforated sigmoid diverticulitis: a promising alternative to more radical procedures. J Am Coll Surg. 2008;206(4):654-7.
Bretagnol, F., Pautrat, K., Mor, C., Benchellal, Z., Huten, N., & de Calan, L. (2008). Emergency laparoscopic management of perforated sigmoid diverticulitis: a promising alternative to more radical procedures. Journal of the American College of Surgeons, 206(4), 654-7. https://doi.org/10.1016/j.jamcollsurg.2007.11.018
Bretagnol F, et al. Emergency Laparoscopic Management of Perforated Sigmoid Diverticulitis: a Promising Alternative to More Radical Procedures. J Am Coll Surg. 2008;206(4):654-7. PubMed PMID: 18387470.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency laparoscopic management of perforated sigmoid diverticulitis: a promising alternative to more radical procedures. AU - Bretagnol,Frederic, AU - Pautrat,Karine, AU - Mor,Caroline, AU - Benchellal,Zin, AU - Huten,Noel, AU - de Calan,Loik, Y1 - 2008/02/01/ PY - 2007/09/13/received PY - 2007/10/28/revised PY - 2007/11/27/accepted PY - 2008/4/5/pubmed PY - 2008/4/23/medline PY - 2008/4/5/entrez SP - 654 EP - 7 JF - Journal of the American College of Surgeons JO - J Am Coll Surg VL - 206 IS - 4 N2 - BACKGROUND: Classic emergency surgical management of complicated perforated sigmoid diverticulitis is based on the principle of a two-stage operation, with colon resection and temporary stoma (Hartmann's procedure). But the later second-stage operation can be technically difficult and can be associated with a significant morbidity rate. We argue that laparoscopy may be beneficial in such patients with peritonitis in terms of operative results and could facilitate later surgical management. STUDY DESIGN: We studied all consecutive patients with perforated sigmoid diverticulitis requiring emergency surgery between January 2000 and December 2004. RESULTS: Twenty-four patients underwent emergency laparoscopic management for perforated sigmoid diverticulitis. Nineteen patients (80%) were found to have a purulent or fecal diffuse peritonitis. No conversion and colostomy were necessary. The overall morbidity rate was 8%; 2 patients with pelvic abscesses required radiologic drainage. The median hospital stay was 12 days (range 7 to 35 days). Prophylactic sigmoid resection was performed by laparoscopy in all patients, with a conversion rate of 16%. CONCLUSIONS: Laparoscopic treatment of generalized peritonitis secondary to diverticulitis is feasible and safe and may be a promising alternative to more radical surgery in selected patients, avoiding fecal diversion and allowing a delayed elective laparoscopic sigmoid resection. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/18387470/Emergency_laparoscopic_management_of_perforated_sigmoid_diverticulitis:_a_promising_alternative_to_more_radical_procedures_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(07)01925-4 DB - PRIME DP - Unbound Medicine ER -