Preliminary experience with laparoscopic peritoneal lavage for complicated diverticulitis

A new algorithm for treatment?

Sara M. Edeiken, Robert Maxwell, Benjamin W. Dart IV, Vincente A. Mejia

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Patients with findings suggestive of a perforated diverticulitis may be subject to colostomy with the attendant morbidity and quality-of-life concerns. Recent literature demonstrates decreased use of laparotomy and colostomy when diagnostic laparoscopy reveals absence of fecal peritonitis. Ten patients presenting with diverticulitis between May 2009 and February 2012 underwent diagnostic laparoscopy. The indication for surgery in nine patients was failure of medical management with or without percutaneous drainage and one had significant pneumoperitoneum at presentation. A comprehensive algorithm was subsequently developed governing medical and surgical management of diverticulitis including the use of diagnostic laparoscopy and laparoscopic peritoneal lavage for patients with Hinchey Stage 3 diverticulitis or abscess formation not amenable to percutaneous drainage. Eight patients underwent diagnostic laparoscopy and laparoscopic peritoneal lavage, whereas two patients underwent diagnostic laparoscopy with conversion to open procedures (low-anterior resection with diverting ileostomy and Hartmann's procedure). Mortality was 0 per cent. Four patients were subsequently readmitted for relapse or recurrence. Two required laparotomy at the time of readmission, ultimately receiving a diagnosis of adenocarcinoma. Two were managed medically and later underwent elective laparoscopic sigmoid colon resection. Diagnostic laparoscopy and laparoscopy peritoneal lavage appear feasible and safe and may be an alternative to more invasive surgery, avoiding laparotomy and colostomy and staging patients for elective laparoscopic resection. Based on our institutional experience, we propose a novel algorithm for the treatment of hospitalized patients with diverticulitis, which incorporates diagnostic laparoscopy and laparoscopic peritoneal lavage while emphasizing patient selection based on clinical examination and imaging.

Original languageEnglish (US)
Pages (from-to)819-825
Number of pages7
JournalAmerican Surgeon
Volume79
Issue number8
StatePublished - Aug 1 2013

Fingerprint

Peritoneal Lavage
Diverticulitis
Laparoscopy
Colostomy
Laparotomy
Therapeutics
Drainage
Conversion to Open Surgery
Recurrence
Ileostomy
Pneumoperitoneum
Sigmoid Colon
Peritonitis
Abscess
Patient Selection
Adenocarcinoma
Quality of Life
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Preliminary experience with laparoscopic peritoneal lavage for complicated diverticulitis : A new algorithm for treatment? / Edeiken, Sara M.; Maxwell, Robert; Dart IV, Benjamin W.; Mejia, Vincente A.

In: American Surgeon, Vol. 79, No. 8, 01.08.2013, p. 819-825.

Research output: Contribution to journalArticle

Edeiken, Sara M. ; Maxwell, Robert ; Dart IV, Benjamin W. ; Mejia, Vincente A. / Preliminary experience with laparoscopic peritoneal lavage for complicated diverticulitis : A new algorithm for treatment?. In: American Surgeon. 2013 ; Vol. 79, No. 8. pp. 819-825.
@article{b70e783cf215429ea77d50cbea585394,
title = "Preliminary experience with laparoscopic peritoneal lavage for complicated diverticulitis: A new algorithm for treatment?",
abstract = "Patients with findings suggestive of a perforated diverticulitis may be subject to colostomy with the attendant morbidity and quality-of-life concerns. Recent literature demonstrates decreased use of laparotomy and colostomy when diagnostic laparoscopy reveals absence of fecal peritonitis. Ten patients presenting with diverticulitis between May 2009 and February 2012 underwent diagnostic laparoscopy. The indication for surgery in nine patients was failure of medical management with or without percutaneous drainage and one had significant pneumoperitoneum at presentation. A comprehensive algorithm was subsequently developed governing medical and surgical management of diverticulitis including the use of diagnostic laparoscopy and laparoscopic peritoneal lavage for patients with Hinchey Stage 3 diverticulitis or abscess formation not amenable to percutaneous drainage. Eight patients underwent diagnostic laparoscopy and laparoscopic peritoneal lavage, whereas two patients underwent diagnostic laparoscopy with conversion to open procedures (low-anterior resection with diverting ileostomy and Hartmann's procedure). Mortality was 0 per cent. Four patients were subsequently readmitted for relapse or recurrence. Two required laparotomy at the time of readmission, ultimately receiving a diagnosis of adenocarcinoma. Two were managed medically and later underwent elective laparoscopic sigmoid colon resection. Diagnostic laparoscopy and laparoscopy peritoneal lavage appear feasible and safe and may be an alternative to more invasive surgery, avoiding laparotomy and colostomy and staging patients for elective laparoscopic resection. Based on our institutional experience, we propose a novel algorithm for the treatment of hospitalized patients with diverticulitis, which incorporates diagnostic laparoscopy and laparoscopic peritoneal lavage while emphasizing patient selection based on clinical examination and imaging.",
author = "Edeiken, {Sara M.} and Robert Maxwell and {Dart IV}, {Benjamin W.} and Mejia, {Vincente A.}",
year = "2013",
month = "8",
day = "1",
language = "English (US)",
volume = "79",
pages = "819--825",
journal = "American Surgeon",
issn = "0003-1348",
publisher = "Southeastern Surgical Congress",
number = "8",

}

TY - JOUR

T1 - Preliminary experience with laparoscopic peritoneal lavage for complicated diverticulitis

T2 - A new algorithm for treatment?

AU - Edeiken, Sara M.

AU - Maxwell, Robert

AU - Dart IV, Benjamin W.

AU - Mejia, Vincente A.

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Patients with findings suggestive of a perforated diverticulitis may be subject to colostomy with the attendant morbidity and quality-of-life concerns. Recent literature demonstrates decreased use of laparotomy and colostomy when diagnostic laparoscopy reveals absence of fecal peritonitis. Ten patients presenting with diverticulitis between May 2009 and February 2012 underwent diagnostic laparoscopy. The indication for surgery in nine patients was failure of medical management with or without percutaneous drainage and one had significant pneumoperitoneum at presentation. A comprehensive algorithm was subsequently developed governing medical and surgical management of diverticulitis including the use of diagnostic laparoscopy and laparoscopic peritoneal lavage for patients with Hinchey Stage 3 diverticulitis or abscess formation not amenable to percutaneous drainage. Eight patients underwent diagnostic laparoscopy and laparoscopic peritoneal lavage, whereas two patients underwent diagnostic laparoscopy with conversion to open procedures (low-anterior resection with diverting ileostomy and Hartmann's procedure). Mortality was 0 per cent. Four patients were subsequently readmitted for relapse or recurrence. Two required laparotomy at the time of readmission, ultimately receiving a diagnosis of adenocarcinoma. Two were managed medically and later underwent elective laparoscopic sigmoid colon resection. Diagnostic laparoscopy and laparoscopy peritoneal lavage appear feasible and safe and may be an alternative to more invasive surgery, avoiding laparotomy and colostomy and staging patients for elective laparoscopic resection. Based on our institutional experience, we propose a novel algorithm for the treatment of hospitalized patients with diverticulitis, which incorporates diagnostic laparoscopy and laparoscopic peritoneal lavage while emphasizing patient selection based on clinical examination and imaging.

AB - Patients with findings suggestive of a perforated diverticulitis may be subject to colostomy with the attendant morbidity and quality-of-life concerns. Recent literature demonstrates decreased use of laparotomy and colostomy when diagnostic laparoscopy reveals absence of fecal peritonitis. Ten patients presenting with diverticulitis between May 2009 and February 2012 underwent diagnostic laparoscopy. The indication for surgery in nine patients was failure of medical management with or without percutaneous drainage and one had significant pneumoperitoneum at presentation. A comprehensive algorithm was subsequently developed governing medical and surgical management of diverticulitis including the use of diagnostic laparoscopy and laparoscopic peritoneal lavage for patients with Hinchey Stage 3 diverticulitis or abscess formation not amenable to percutaneous drainage. Eight patients underwent diagnostic laparoscopy and laparoscopic peritoneal lavage, whereas two patients underwent diagnostic laparoscopy with conversion to open procedures (low-anterior resection with diverting ileostomy and Hartmann's procedure). Mortality was 0 per cent. Four patients were subsequently readmitted for relapse or recurrence. Two required laparotomy at the time of readmission, ultimately receiving a diagnosis of adenocarcinoma. Two were managed medically and later underwent elective laparoscopic sigmoid colon resection. Diagnostic laparoscopy and laparoscopy peritoneal lavage appear feasible and safe and may be an alternative to more invasive surgery, avoiding laparotomy and colostomy and staging patients for elective laparoscopic resection. Based on our institutional experience, we propose a novel algorithm for the treatment of hospitalized patients with diverticulitis, which incorporates diagnostic laparoscopy and laparoscopic peritoneal lavage while emphasizing patient selection based on clinical examination and imaging.

UR - http://www.scopus.com/inward/record.url?scp=84882307831&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84882307831&partnerID=8YFLogxK

M3 - Article

VL - 79

SP - 819

EP - 825

JO - American Surgeon

JF - American Surgeon

SN - 0003-1348

IS - 8

ER -