Conservative laparoscopic treatment of diverticular peritonitis

Goal. - To evaluate the results of a strategy of conservative laparoscopic treatment of peritonitis due to perforated diverticulitis for all patients, without exception for intraoperative findings or general patient condition, and to study the feasibility of eventual second-stage laparoscopic colectomy. Materials and methods. - Between January 2003 and May 2007, 25 consecutive patients were urgently hospitalized with acute peritonitis due to perforated diverticulitis. All patients underwent laparoscopic peritoneat lavage and debridement; when there was a large perforation (ten cases), suture closure under laparoscopic control was performed. The Hinchey classification of peritonitis was Stage I in 2, Stage 1113 in 8, Stage III in 9, and Stage IV in 6. Results. - Postoperative morbidity occurred in 12% of cases. Mean operative time was 71 minutes. Conversion to open laparotomy was not required. Complications included residual abscess (drained percutaneously with CT guidance), urinary tract infection, and prolonged drainage via the drain tract. Mortality was zero. Mean hospital stay was 13.8 days. Sixteen patients (64%) subsequently underwent laparoscopic colectomy as a second stage procedure. Conclusion. - Conservative laparoscopic treatment of acute peritonitis due to perforated diverticulitis is a reliable alternative to open laparotomy in many cases; eventual laparoscopic colectomy at a subsequent stage is possible in the majority of patients. (C) 2009 Elsevier Masson SAS. All rights reserved.