RESUMO
BACKGROUND: The standard treatment for Hinchey III perforated diverticulitis with peritonitis was resection with or without a stoma, but recent trials have shown that laparoscopic lavage is a reasonable alternative. This registry-based Swedish study investigated results at a national level to assess safety in real-world scenarios. METHODS: Patients in Sweden who underwent emergency surgery for perforated diverticulitis between 2016 and 2018 were studied. Inverse probability weighting by propensity score was used to adjust for confounding factors. RESULTS: A total of 499 patients were included in this study. Laparoscopic lavage was associated with a significantly lower 90-day Comprehensive Complication Index (20.9 versus 32.0; odds ratio 0.77, 95 per cent compatibility interval (c.i.) 0.61 to 0.97) and overall duration of hospital stay (9 versus 15 days; ratio of means 0.84, 95 per cent c.i. 0.74 to 0.96) compared with resection. Patients had 82 (95 per cent c.i. 39 to 140) per cent more readmissions following lavage than resection (27.2 versus 21.0 per cent), but similar reoperation rates. More co-morbidity was noted among patients who underwent resection than those who had laparoscopic lavage. CONCLUSION: Laparoscopic lavage is safe in routine care beyond trial evaluations.
Diverticulitis comprises inflammation in pouches (diverticula) of the large intestine. In the most severe instances, this inflammation can cause perforation of the bowel with purulent or faecal peritonitis. If this happens, surgery is needed. The traditional method has been resection of the inflamed bowel with a stoma. A new technique has been proposed whereby the abdomen is rinsed with saline laparoscopically and a drain is placed (laparoscopic lavage). This study aimed to compare these two methods in terms of clinical short-term outcomes, with a focus on complications. It was found that laparoscopic lavage had fewer complications than resectional surgery and a shorter hospital stay. The new method was safe when used in Swedish routine care.
