Outcomes Favor Colon Resection in Perforated Diverticulitis
(HealthDay News) — Laparoscopic lavage leads to worse outcomes than primary resection in patients with perforated diverticulitis, according to a study published in the Oct. 6 issue of the Journal of the American Medical Association.
In a randomized clinical superiority trial, Johannes Kurt Schultz, M.D., from Akershus University Hospital in Lørenskog, Norway, and colleagues compared the outcomes of 101 patients treated with laparoscopic peritoneal lavage with outcomes of 98 patients treated with colon resection for perforated diverticulitis at 21 centers in Sweden and Norway from February 2010 to June 2014. Severe postoperative complications were evaluated for 90 days using medical records.
The researchers found that there were severe postoperative complications in 31 of 101 patients (30.7 percent) in the laparoscopic lavage group and 25 of 96 patients (26 percent) in the colon resection group (difference, 4.7 percent; P = 0.53). There were no significant differences between the groups with respect to mortality at 90 days. For patients who did not have fecal peritonitis, the laparoscopic lavage group had a higher reoperation rate (20.3 percent) than the colon resection group (5.7 percent; P = 0.01). In the laparoscopic lavage group, the length of operating time was significantly shorter, while length of postoperative hospital stay and quality of life did not differ significantly between groups. Laparoscopic lavage missed four sigmoid carcinomas.
"Among patients with likely perforated diverticulitis and undergoing emergency surgery, the use of laparoscopic lavage versus primary resection did not reduce severe postoperative complications and led to worse outcomes in secondary end points," the authors write.