A Meta-Analysis of Short-Term Outcomes After Laparoscopic Lavage Versus Colonic Resection in the Treatment of Perforated Diverticulitis
- PMID: 36938197
- PMCID: PMC10018325
- DOI: 10.7759/cureus.34953
A Meta-Analysis of Short-Term Outcomes After Laparoscopic Lavage Versus Colonic Resection in the Treatment of Perforated Diverticulitis
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.
Copyright © 2023, Tiong et al.
Conflict of interest statement
The authors have declared that no competing interests exist.
Figures
Similar articles
-
Laparoscopic Lavage Versus Primary Resection for Acute Perforated Diverticulitis: Review and Meta-analysis.Ann Surg. 2018 Feb;267(2):252-258. doi: 10.1097/SLA.0000000000002236. Ann Surg. 2018. PMID: 28338510 Review.
-
Laparoscopic Lavage in the Management of Perforated Diverticulitis: a Contemporary Meta-analysis.J Gastrointest Surg. 2017 Sep;21(9):1491-1499. doi: 10.1007/s11605-017-3462-6. Epub 2017 Jun 12. J Gastrointest Surg. 2017. PMID: 28608041 Review.
-
Laparoscopic lavage versus surgical resection for acute diverticulitis with generalised peritonitis: a systematic review and meta-analysis.Tech Coloproctol. 2017 Feb;21(2):93-110. doi: 10.1007/s10151-017-1585-0. Epub 2017 Feb 15. Tech Coloproctol. 2017. PMID: 28197792 Review.
-
Meta-analysis of surgical strategies in perforated left colonic diverticulitis with generalized peritonitis.Langenbecks Arch Surg. 2018 Jun;403(4):425-433. doi: 10.1007/s00423-018-1686-x. Epub 2018 Jun 9. Langenbecks Arch Surg. 2018. PMID: 29931505 Review.
-
Is laparoscopic lavage safe in purulent diverticulitis versus colonic resection? A systematic review and meta-analysis.Int J Surg. 2019 Nov;71:182-189. doi: 10.1016/j.ijsu.2019.10.007. Epub 2019 Oct 11. Int J Surg. 2019. PMID: 31610284
Cited by
-
Long-Term Results After Laparoscopic Lavage for Perforated Diverticulitis Purulent Peritonitis in Sweden: A Population-Based Observational Study.Ann Surg Open. 2024 May 13;5(2):e433. doi: 10.1097/AS9.0000000000000433. eCollection 2024 Jun. Ann Surg Open. 2024. PMID: 38911640 Free PMC article.
References
-
- 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
-
- 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
-
- 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
-
- 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
Publication types
LinkOut - more resources
Full Text Sources