Long-Term Outcomes of Laparoscopic Peritoneal Lavage for Complicated Diverticulitis in a Dedicated Emergency Surgery Service

Rhodes K and Behar N

Emergency Surgery Department, Chelsea and Westminster Hospital, UK

^*Correspondance to: Nebil Behar 

 PDF  Full Text DOI: 10.25107/2474-1647.1066

Abstract

Aim: A dedicated emergency surgery service allows for faster accumulation of experience in procedures that are otherwise infrequent; laparoscopic peritoneal lavage (LPL) of complicated diverticulitis is one such procedure. We describe our long-term outcomes on an intention to treat basis with LPL.Method: Data was collected on 31 consecutive patients undergoing LPL in our unit between 2011 and 2015. Outcomes assessed were post-operative complications including the requirement for further interventions, length of stay and mortality. All patients requiring surgery underwent initial laparoscopy with a view to lavage without resection.Results: In the early outcomes, across all Hinchey grades, there were 6 further radiological or operative interventions out of 31 (19%). There were no deaths. In the late outcomes (median 34 months follow up), across all Hinchey grades, there were 7 further operative interventions out of 31 (23%). There were 5 deaths overall (16%) with mean days to death of 498 days. All deaths were of non surgical causes. Two cancers were detected due to our routine policy of colonoscopic follow up. 3 out of 22 (14%) remaining patients with non-respected colon were admitted with uncomplicated diverticulitis during median follow up period of 34 months.Conclusion: Laparoscopy with a view to washout on an intention to treat basis appears safe, across all Hinchey grades of diverticulitis within the context of close post-operative monitoring and colonoscopic follow up. LPL also allows laparoscopic relief of small bowel obstruction in patients presenting with this bystander complication of diverticulitis. Further radiological drainage after LPL in this study appears feasible without resorting to resection although 1 of 3 patients progressed to a Hartmann’s procedure which was uneventful. Based on our findings of subsequent malignancy in two patients, we would advise timely post-operative colonoscopy and follow up in all patients.

Keywords

Cite the article

Rhodes K, Behar N. Long-Term Outcomes of Laparoscopic Peritoneal Lavage for Complicated Diverticulitis in a Dedicated Emergency Surgery Service. Clin Surg. 2016; 1: 1066.