CR09 *LAPAROSCOPIC WASHOUT FOR DIVERTICULITIS

Abstract

Background: Hartmann's procedure has been the treatment for complicated perforated diverticular disease. Laparoscopic washout with colonic preservation can replace radical resection. Laparoscopic washout is associated with less morbidity, mortality and improved quality of life.Methods: An 8‐year retrospective review of 80 consecutive cases of sigmoid diverticulitis warranting emergency surgical intervention (2000–2008). During this time approximately 2000 admissions for diverticulitis were recorded.Results: Hinchey grades were I(10), II(26), III(38) and IV(6).Patients age mean 77, median 74. Procedures performed were Laparoscopic washout (34), Hartmann's procedure (34), percutaneous drainage of abscess (5), resection and primary anastomosis (3).Overall mortality was 7% (all in the Hartmann's group). Washout achieved success in 28 of 34 cases without immediate colonic resection. Short‐term failures of washout in 6 were due to perforated cancer (2), faecal fistula formation (2), inadequate washout and ongoing sepsis (2). All failures underwent Hartmann's resection without complication. In long‐term follow up 8 patients developed symptoms of recurrent complicated diverticulitis including (delayed stricture, fistulae and repeat perforation) and underwent sigmoid resection. 8 patients underwent planned resection without experiencing further symptoms. 10 patients were observed without symptoms with mean follow up of 20 months.Conclusions: Laparoscopic washout is superior in cases of perforated Diverticulitis with purulent peritonitis(Hinchey III). It is recommended in Hinchey I and II cases, when percutaneous drainage is unhelpful. Hartmann's colonic resection should be reserved for genuine cases of faecal peritonitis (Hinchey IV).