Laparoscopic two-stage left colonic resection for patients with peritonitis caused by acute diverticulitis

PURPOSE: Purulent or fecal peritonitis is one of the most serious complications of acute diverticulitis. Up to one-fourth of patients hospitalized for acute diverticulitis require an emergent operation for a complication, including abscess, peritonitis, or stenosis. Open Hartmanns procedure has been the operation of choice for these patients. The advantages of laparoscopy could be combined with those of the primary resection in selected patients with peritonitis complicating acute diverticulitis. However, because of technical difficulties and the theoretic risk of poorly controlled sepsis, laparoscopic Hartmanns procedure has been seldom reported for such patients. METHODS: Data were prospectively collected from 2003 to 2005 in a single referral center specialized in abdominal emergencies. Laparoscopic Hartmanns procedure (Stage 1) was performed in selected patients with peritonitis complicating acute diverticulitis. Secondarily, Hartmanns reversal (Stage 2) also was performed laparoscopically. RESULTS: Thirty-one patients were studied. The median Mannheim Peritonitis Index score was 21 ( +/- 5; range, 12 - 32). The conversion rate was 19 and 11 percent for Stage 1 and Stage 2, respectively. There was no perioperative uncontrolled sepsis. Overall operative 30- day mortality and morbidity rates were 3 and 23 percent for Stage 1, and 0 and 15 percent for Stage 2, respectively. Stoma reversal was possible in 90 percent of patients. CONCLUSIONS: The results of this small series demonstrated that the indications of laparoscopy in diverticulitis could be extrapolated to selected patients with peritonitis. The technical feasibility and safety of laparoscopic Hartmann procedure in selected patients seem acceptable. However, larger- scale, controlled studies are needed to define more accurately the role of laparoscopy in complicated diverticulitis.