期刊
COLORECTAL DISEASE
卷 8, 期 6, 页码 501-505出版社
WILEY
DOI: 10.1111/j.1463-1318.2006.01011.x
关键词
diverticulitis; laparoscopy; peritonitis; diverticular disease; surgery
Objectives Surgical options for acute diverticulitis with peritonitis include Hartmann's procedure or resection and primary anastomosis with or without a stoma. Initial laparoscopic lavage and drainage can control the acute intra-abdominal sepsis to allow for a delayed definitive procedure in nonemergency conditions. Potential advantages include the avoidance of a laparotomy, stoma and local infections at the origin of dehiscence and incisional hernias. We evaluated this approach in a selected group of patients. Methods Patients with intra-abdominal pus secondary to diverticular perforation requiring surgery were included in the study. Patients with localized pus amenable to computerized tomography (CT)-guided drainage, faecal peritonitis, severe generalized peritonitis, and those in which the perforation was spontaneously visible were excluded. Standard demographic data, CT findings, intra-operative findings and postoperative outcomes were analysed. Results Ten patients were suitable for the approach. Mean patient age was 60.2 years. Mean body mass index was 28.2 m(2)/kg. Mean postoperative stay was 8.5 days and uneventful in all patients. One patient re-presented after 3 weeks with acute peritonitis requiring open sigmoidectomy. Six patients successfully underwent laparoscopic sigmoidectomy with primary anastomosis 2-3 months later. Two patients were not re-operated because of comorbidity and one refused surgery. Conclusions A two-stage totally minimally invasive approach may be a safe alternative strategy for selected cases of acute complicated diverticulitis.
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