Diverticulitis Research Today is a free monthly online journal that collates and summarizes the latest research about Diverticulitis, including details on symptoms, treatment, causes, prevention, diet. | ||||||||
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Emergency laparoscopic management of perforated sigmoid diverticulitis: a promising alternative to more radical procedures.Bretagnol F, Pautrat K, Mor C, Benchellal Z, Huten N, de Calan L Department of Digestive Surgery, Trousseau Hospital, Tours, France. BACKGROUND: Classic emergency surgical management of complicated perforated sigmoid diverticulitis is based on the principle of a two-stage operation, with colon resection and temporary stoma (Hartmann's procedure). But the later second-stage operation can be technically difficult and can be associated with a significant morbidity rate. We argue that laparoscopy may be beneficial in such patients with peritonitis in terms of operative results and could facilitate later surgical management. STUDY DESIGN: We studied all consecutive patients with perforated sigmoid diverticulitis requiring emergency surgery between January 2000 and December 2004. RESULTS: Twenty-four patients underwent emergency laparoscopic management for perforated sigmoid diverticulitis. Nineteen patients (80%) were found to have a purulent or fecal diffuse peritonitis. No conversion and colostomy were necessary. The overall morbidity rate was 8%; 2 patients with pelvic abscesses required radiologic drainage. The median hospital stay was 12 days (range 7 to 35 days). Prophylactic sigmoid resection was performed by laparoscopy in all patients, with a conversion rate of 16%. CONCLUSIONS: Laparoscopic treatment of generalized peritonitis secondary to diverticulitis is feasible and safe and may be a promising alternative to more radical surgery in selected patients, avoiding fecal diversion and allowing a delayed elective laparoscopic sigmoid resection. Published 4 April 2008 in J Am Coll Surg, 206(4): 654-7.
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