Laparoscopic lavage versus primary resection for acute perforated diverticulitis: review and meta-analysis
File(s)
Author(s)
Penna, Marta
Markar, Sheraz R
Mackenzie, Hugh
Hompes, Roel
Cunningham, Chris
Type
Journal Article
Abstract
OBJECTIVE: To compare clinical outcomes after laparoscopic lavage (LL) or colonic resection (CR) for purulent diverticulitis. BACKGROUND: Laparoscopic lavage has been suggested as an alternative treatment for traditional CR. Comparative studies to date have shown conflicting results. METHODS: Electronic searches of Embase, Medline, Web of Science, and Cochrane databases were performed. Weighted mean differences (WMD) were calculated for effect size of continuous variables and pooled odds ratios (POR) calculated for discrete variables. RESULTS: A total of 589 patients recruited from 3 randomized controlled trials (RCTs) and 4 comparative studies were included; 85% as Hinchey III. LL group had younger patients with higher body mass index and lower ASA grades, but comparable Hinchey classification and previous diverticulitis rates. No significant differences were noted for mortality, 30-day reoperations and unplanned readmissions. LL had higher rates of intraabdominal abscesses (POR = 2.85; 95% confidence interval, CI, 1.52-5.34; P = 0.001), peritonitis (POR = 7.80; 95% CI 2.12-28.69; P = 0.002), and increased long-term emergency reoperations (POR = 3.32; 95% CI 1.73-6.38; P < 0.001). Benefits of LL included shorter operative time, fewer cardiac complications, fewer wound infections, and shorter hospital stay. Overall, 90% had stomas after CR, of whom 74% underwent stoma reversal within 12-months. Approximately, 14% of LL patients required a stoma; 48% obtaining gut continuity within 12-months, whereas 36% underwent elective sigmoidectomy. CONCLUSIONS: The preservation of diseased bowel by LL is associated with approximately 3 times greater risk of persistent peritonitis, intraabdominal abscesses and the need for emergency surgery compared with CR. Future studies should focus on developing composite predictive scores encompassing the wide variation in presentations of diverticulitis and treatment tailored on case-by-case basis.
Date Issued
2018-02
Date Acceptance
2018-02-01
Citation
Annals of Surgery, 2018, 267 (2), pp.252-258
ISSN
0003-4932
Publisher
Lippincott, Williams & Wilkins
Start Page
252
End Page
258
Journal / Book Title
Annals of Surgery
Volume
267
Issue
2
Copyright Statement
© 2018 Lippincott Williams & Wilkins, Inc. This is a non-final version of an article published in final form in Annals of Surgery, February 2018, Volume 267, Issue 2, p252–258, https://dx.doi.org/10.1097/SLA.0000000000002236
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/28338510
Subjects
11 Medical And Health Sciences
Surgery
Publication Status
Published
Coverage Spatial
United States