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Laparoscopic treatment in acute complicated diverticulitis: a review of 11 cases.
Acta Chir Belg. 2009 Jan-Feb; 109(1):56-60.AC

Abstract

AIMS

We wanted to test the role of laparoscopy in complicated diverticulitis.

METHODS

All acute complicated sigmoid diverticulitis cases were reviewed during the last 6 years (December 1999 to 2006). Patients whose medical treatment had failed and patients admitted with peritonitis underwent emergency surgery. However, only laparoscopic procedures were included in the study. Patients were programmed 2 to 4 months later for laparoscopic elective colon resection if they underwent first lavage and drainage of the peritoneal cavity.

RESULTS

Eleven patients were treated by laparoscopic procedures out of a total of 37 who underwent emergency surgical therapy for acute perforated diverticulitis. Laparoscopic resection with primary anastomosis was performed in 2 patients (Hinchey I and IIA). Laparoscopic lavage and drainage was performed in the remaining 9 patients (one stage IIA, three stage IIB and five stage III). Three conversions into open Hartmann were needed (stage III). One patient (stage IIB) was lost during follow-up and reappeared 16 months later in general peritonitis. Two patients needed earlier resection because of persistent symptoms. Three remaining patients had a 2nd stage resection at the allocated time. No postoperative death was encountered. Long-term follow-up (mean 6 months) showed one incisional hernia in a converted patient.

DISCUSSION

In perforated diverticular disease, even though laparoscopic lavage and drainage avoids a colostomy and facilitates a 2nd stage resection, few patients have complete resolution of the inflammatory process. Resection remains mandatory after 8 to 12 weeks. In Hinchey stage III, the success rate still remains to be investigated and weighed against the Hartmann procedure or primary resection. Faecal peritonitis and instable patients should not be considered for laparoscopy.

Authors+Show Affiliations

Department of abdominal surgery, St. Joseph Hospital, Gilly, Belgium.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19341197

Citation

Lam, H D., et al. "Laparoscopic Treatment in Acute Complicated Diverticulitis: a Review of 11 Cases." Acta Chirurgica Belgica, vol. 109, no. 1, 2009, pp. 56-60.
Lam HD, Tinton N, Cambier E, et al. Laparoscopic treatment in acute complicated diverticulitis: a review of 11 cases. Acta Chir Belg. 2009;109(1):56-60.
Lam, H. D., Tinton, N., Cambier, E., & Navez, B. (2009). Laparoscopic treatment in acute complicated diverticulitis: a review of 11 cases. Acta Chirurgica Belgica, 109(1), 56-60.
Lam HD, et al. Laparoscopic Treatment in Acute Complicated Diverticulitis: a Review of 11 Cases. Acta Chir Belg. 2009 Jan-Feb;109(1):56-60. PubMed PMID: 19341197.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic treatment in acute complicated diverticulitis: a review of 11 cases. AU - Lam,H D, AU - Tinton,N, AU - Cambier,E, AU - Navez,B, PY - 2009/4/4/entrez PY - 2009/4/4/pubmed PY - 2009/5/9/medline SP - 56 EP - 60 JF - Acta chirurgica Belgica JO - Acta Chir Belg VL - 109 IS - 1 N2 - AIMS: We wanted to test the role of laparoscopy in complicated diverticulitis. METHODS: All acute complicated sigmoid diverticulitis cases were reviewed during the last 6 years (December 1999 to 2006). Patients whose medical treatment had failed and patients admitted with peritonitis underwent emergency surgery. However, only laparoscopic procedures were included in the study. Patients were programmed 2 to 4 months later for laparoscopic elective colon resection if they underwent first lavage and drainage of the peritoneal cavity. RESULTS: Eleven patients were treated by laparoscopic procedures out of a total of 37 who underwent emergency surgical therapy for acute perforated diverticulitis. Laparoscopic resection with primary anastomosis was performed in 2 patients (Hinchey I and IIA). Laparoscopic lavage and drainage was performed in the remaining 9 patients (one stage IIA, three stage IIB and five stage III). Three conversions into open Hartmann were needed (stage III). One patient (stage IIB) was lost during follow-up and reappeared 16 months later in general peritonitis. Two patients needed earlier resection because of persistent symptoms. Three remaining patients had a 2nd stage resection at the allocated time. No postoperative death was encountered. Long-term follow-up (mean 6 months) showed one incisional hernia in a converted patient. DISCUSSION: In perforated diverticular disease, even though laparoscopic lavage and drainage avoids a colostomy and facilitates a 2nd stage resection, few patients have complete resolution of the inflammatory process. Resection remains mandatory after 8 to 12 weeks. In Hinchey stage III, the success rate still remains to be investigated and weighed against the Hartmann procedure or primary resection. Faecal peritonitis and instable patients should not be considered for laparoscopy. SN - 0001-5458 UR - https://www.unboundmedicine.com/medline/citation/19341197/Laparoscopic_treatment_in_acute_complicated_diverticulitis:_a_review_of_11_cases_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=19341197.ui DB - PRIME DP - Unbound Medicine ER -