Laparoscopic Peritoneal Lavage vs Laparoscopic Sigmoidectomy in Perforated Acute Diverticulitis: A Multicenter Prospective Observational Study

Introduction. Laparoscopic peritoneal lavage (LPL) is a feasible method of source control in selected patients with pelvic abscess and generalized purulent peritonitis caused by acute diverticulitis. We aimed to compare the results of LPL and laparoscopic sigmoidectomy (LS) in patients undergone surgery for complicated acute diverticulitis. Methods. This prospective, observational, multicenter study included patients with a pelvic abscess not amenable to conservative management and patients with a Hinchey III acute diverticulitis observed from 2015 to 2018. Sixty-six patients were enrolled: 28 (42%) underwent LPL, 38 (58%) LS. In LS, patients had a primary anastomosis (PA), with or without a temporary diversion, or an end colostomy (HA). Mortality, morbidity, failure of source control, redo surgery, length of stay and recurrence of diverticulitis were the major outcome measures. Results. Patients’ demographics were similar in the two groups. In LPL group, a higher number of patients had an ASA score >2 (p= 0.05), and the Mannheim Peritonitis Index was significantly higher (p=0.004). In the LS group, 24 patients (63%) had a PA, and 14 (37%) an HA. No death was recorded. Overall, morbidity was 33% in LPL and 18% in LS (p=0.169). However, a failure to achieve the source control of the peritoneal infection and the need to return to the operating room were significantly more frequent in LPL (p=0.002 and p=0.006). Mean postoperative length of stay was comparable (11.4 vs. 8.23 days; p=0.08). In the follow-up, the risk of an episode of diverticular recurrence was significantly higher in LPL (p= 0.003). Conclusions: Although less invasive, LPL carries significant drawbacks. The implementation of LPL should be limited to patients able to tolerate a persistent or recurrent status of sepsis and multiple operations for the ultimate source control.