Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Feb 14;15(2):e34953.
doi: 10.7759/cureus.34953. eCollection 2023 Feb.

A Meta-Analysis of Short-Term Outcomes After Laparoscopic Lavage Versus Colonic Resection in the Treatment of Perforated Diverticulitis

Affiliations
Review

A Meta-Analysis of Short-Term Outcomes After Laparoscopic Lavage Versus Colonic Resection in the Treatment of Perforated Diverticulitis

Jonathan Tiong et al. Cureus. .

Abstract

The management of perforated non-faeculent diverticulitis has traditionally involved performing a colonic resection (CR). Laparoscopic lavage (LL) has emerged as a less invasive alternative in recent years. The aim of this meta-analysis was to assess the role of LL in the surgical treatment of perforated non-faeculent diverticulitis. To that end, we conducted a search on Embase, Medline, and Cochrane databases for comparative studies in the English language published till June 2021 [PROSPERO (CRD42021269410)]. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomised trials (RoB 2) and the methodological index for non-randomised studies (MINORS). Data were analysed using Cochrane RevMan. Pooled odds ratio (POR) and cumulative weighted ratios (CWR) were calculated. A total of 13 studies involving 1061 patients were found eligible, including seven studies based on three randomised control trials (RCTs). LL was associated with a reduced risk of wound infection, stoma formation, and need for further surgery by 77% [POR: 0.23, 95% confidence interval (CI): 0.07-0.74], 83% (POR: 0.17, 95% CI: 0.05-0.56), and 53% (POR: 0.47, 95% CI: 0.23-0.97) respectively. Duration of surgery and hospitalisation was reduced by 54% and 43% respectively. However, LL was associated with higher rates of unplanned reoperations (POR: 2.05, 95% CI: 1.22-3.42), recurrence (POR: 9.47, 95% CI: 3.24-27.67), and peritonitis (POR: 8.92, 95% CI: 2.71-29.33). No differences in mortality or readmission rates were observed. LL in Hinchey III diverticulitis lowers the incidence of stoma formation and overall reoperations without an increase in mortality but at the cost of higher recurrence rates and peritonitis. A limitation of this study was the inclusion of non-RCTs. An elective resection should be considered after LL. Guidelines for surgical techniques in LL need to be standardised.

Keywords: colonic resection; complicated diverticulitis; hinchey classification; laparoscopic lavage; perforated diverticulitis; sigmoid diverticulitis.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flow diagram depicting the literature search
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Cochrane risk-of-bias 2 assessment of randomised controlled trials included in the meta-analysis
Figure 3
Figure 3. Dichotomous outcomes favouring LL
CI: confidence interval; CR: colonic resection; LL: laparoscopic lavage
Figure 4
Figure 4. Dichotomous variables favouring CR
CI: confidence interval; CR: colonic resection; LL: laparoscopic lavage

Similar articles

Cited by

References

    1. Burden of gastrointestinal disease in the United States: 2012 update. Peery AF, Dellon ES, Lund J, et al. Gastroenterology. 2012;143:1179–1187. - PMC - PubMed
    1. Treatment of patients with acute colonic diverticulitis complicated by abscess formation: a systematic review. Gregersen R, Mortensen LQ, Burcharth J, Pommergaard HC, Rosenberg J. Int J Surg. 2016;35:201–208. - PubMed
    1. The American Society of Colon and Rectal Surgeons Clinical Practice guidelines for the treatment of left-sided colonic diverticulitis. Hall J, Hardiman K, Lee S, et al. Dis Colon Rectum. 2020;63:728–747. - PubMed
    1. Laparoscopic management of generalized peritonitis due to perforated colonic diverticula. O'Sullivan GC, Murphy D, O'Brien MG, Ireland A. Am J Surg. 1996;171:432–434. - PubMed
    1. Multicentre international trial of laparoscopic lavage for Hinchey III acute diverticulitis (LLO Study) Binda GA, Bonino MA, Siri G, et al. Br J Surg. 2018;105:1835–1843. - PubMed

LinkOut - more resources