BACKGROUND: Laparoscopic lavage has shown promising results in nonfeculent perforated diverticulitis. It is an appealing strategy; it avoids the complications associated with resection. However, there has been some reluctance to widespread uptake because of the scarcity of large-scale studies.
OBJECTIVE: This study investigated national trends in management of perforated diverticulitis.
DESIGN: This retrospective population study used an Irish national database to identify patients acutely admitted with diverticulitis, as defined by the International Classification of Diseases. Demographics, procedures, comorbidities, and outcomes were obtained for the years 1995 to 2008.
SETTINGS: The study was conducted in Ireland.
PATIENTS: Patients with International Classification of Diseases codes corresponding to diverticulitis who underwent operative intervention were included.
MAIN OUTCOME MEASURES: The primary outcome was mortality, and secondary outcomes were length of stay and postoperative complications.
RESULTS: Two thousand four hundred fifty-five patients underwent surgery for diverticulitis, of whom 427 underwent laparoscopic lavage. Patients selected for laparoscopic lavage had lower mortality (4.0% vs 10.4%, p < 0.001), complications (14.1% vs 25.0%, p < 0.001), and length of stay (10 days vs 20 days, p < 0.001) than those requiring laparotomy/resection. Patients older than 65 years were more likely to die (OR 4.1, p < 0.001), as were those with connective tissue disease (OR 7.3, p < 0.05) or chronic kidney disease (OR 8.0, p < 0.001).
LIMITATIONS: This retrospective study is limited by the quality of data obtained and is subject to selection bias. Furthermore, the lack of disease stratification means it is not possible to identify the extent of peritonitis; feculent peritonitis has worse outcomes and is not likely to be included in the lavage group.
CONCLUSIONS: The number of patients selected for laparoscopic lavage in perforated diverticulitis is increasing, and the outcomes in this study are comparable to other reports. Those patients in whom laparoscopic lavage alone was suitable had lower mortality and morbidity than those in whom resection was considered necessary.
1Institute for Clinical Outcomes Research & Education (iCORE) and Centre for Colorectal Disease, St. Vincent’s University Hospital, Elm Park, Dublin, Ireland
2School of Medicine & Medical Science, University College Dublin, Dublin, Ireland
Funding/Support: This research was supported by a Postgraduate Scholarship from the Irish Research Council for Science, Engineering and Technology (IRCSET) (to A.C.R. and D.C.W.). D.C.W. has been awarded funding for this study from the Health Research Board of Ireland.
Financial Disclosure: Dr Winter is involved in the recruitment phase of a randomized-control trial on laparoscopic lavage (LAPLAND trial NCT01019239 at http://clinicaltrials.gov/show/NCT01019239).
Presented at the meeting of the European Society of Coloproctology, Copenhagen, Denmark, September 25 to 28, 2011.
Correspondence: Dr Desmond C. Winter, M.D., F.R.C.S.I., Department of Surgery, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland. E-mail: firstname.lastname@example.org