Laparoscopic peritoneal lavage versus sigmoidectomy for perforated diverticulitis with purulent peritonitis: three-year follow-up of the randomised LOLA trial

Vincent T Hoek,Belgium A J L D’Hoore,R A Scholte,M G H Besselink,E R Hendriks,E J C Vriens,J F Bartelsman,T S Bijlsma,E W H Waltmann,E H Ponten,D Den Hartog,S Fransen,J W S Merkus,J M Vogten,G A Patijn,J H M B Stoot,R J C L M Vuylsteke,L C De Nes,M M N Leeuwenburgh,A B Smits,A G M Hoofwijk,M S Verweij,H A Cense,M De Brouwer,J F Smulders,K W E Hulsewé,A Van Overstraeten De Buck,M N Sosef,M J Boom,J J A Joosten,M G De Blasiis,M Van Zeeland,W C Hop,M Geerdink,E Jutte,W N Nijboer,A B Kluit,M D P Luyer,A A W Van Geloven ,W F Weidema ,Joos Heisterkamp ,I.h.m Borel Rinkes ,Daniel J Lips ,Marja A Boermeester ,J Melenhorst ,S Mehmedovic,Donald L Van Der Peet ,Robbert J I Bosker ,G I Koff Eman,Charles C Van Rossem ,Jan J Wever ,Marinus J Wiezer ,Werner A Draaisma,D P V Lambrichts ,Brendan Horst ,Niels De Korte ,H B A C Stockmann ,Simon W Nienhuijs ,E.g.j.m Pierik ,P.j Tanis ,Hilko A Swank,E M Von Meijenfeldt,Eric J Hazebroek ,Thomas Karsten ,M Stommel ,Joost M Klaase ,G H H Mannaerts ,Jarmila D W Van Der Bilt ,P P L O Coene ,Marc Miserez ,I.h.j.t De Hingh ,Maarten Vermaas ,Rob A.e.m Tollenaar ,Jefrey Vermeulen ,J F Zengerink,Alexandra Brandt ,I Terrasson,Youssef El-Massoudi ,R.p.r Groenendijk ,Olivier R Busch ,Willem A Bemelman,W H Steup ,Sjoerd C Bruin ,Bart A Van Wagensveld ,Susan Van Dieren,Albert Wolthuis ,Rogier M P H Crolla ,Pieter W Stark,G.d.j Van Olden ,Pauline Middelhoek ,Q A J Eijsbouts ,Salomone Di Saverio ,Esther C J Consten,R T Ottow ,Pieter J Van Huijstee ,C Sietses ,Irene M Mulder ,Joost A.b Van Der Hoeven ,Marlies P Schijven ,Marc J P M Govaert ,T G Frakking ,P W Plaisier ,Abdelali Bentohami ,Jurriaan B Tuynman ,George P Van Der Schelling ,Olaf Schouten ,Christianne J Buskens ,John K Maring ,Mark R De Vries ,Herman Rijna ,Dingeman J Swank ,E Philip Steller ,Gijsbert D Musters ,Eino B Van Duyn ,Johan F Lange,A Legemate,Oddeke Van Ruler ,Eelco J R De Graaf ,C.f.j.m Blanken-Peeters ,Alexander Engel ,Bc Opmeer ,Menno R Vriens ,Gerrit D Slooter ,Jan Van Dalen ,R.j Vos ,D.w Meijer ,Wilhelmina M U Van Grevenstein ,M Durbridge,Philip M Kruyt ,M A W Stam ,D Van Geldere ,Pim P Edomskis,Sandra Vennix,G J Ilbrink,Marinke Westerterp ,Johannes B Reitsma ,Çağdaş Ünlü ,Hubert A Prins ,J Konsten ,Boudewijn R Toorenvliet ,J Diks ,Henderik L Van Westreenen ,G Montfort ,M F Gerhards ,Laurents P S Stassen ,D Nio ,H J Belgers ,Arjen J Witkamp

doi:10.1007/s00464-022-09326-3

Abstract

BackgroundThis study aimed to compare laparoscopic lavage and sigmoidectomy as treatment for perforated diverticulitis with purulent peritonitis during a 36 month follow-up of the LOLA trial.MethodsWithin the LOLA arm of the international, multicentre LADIES trial, patients with perforated diverticulitis with purulent peritonitis were randomised between laparoscopic lavage and sigmoidectomy. Outcomes were collected up to 36 months. The primary outcome of the present study was cumulative morbidity and mortality. Secondary outcomes included reoperations (including stoma reversals), stoma rates, and sigmoidectomy rates in the lavage group.ResultsLong-term follow-up was recorded in 77 of the 88 originally included patients, 39 were randomised to sigmoidectomy (51%) and 38 to laparoscopic lavage (49%). After 36 months, overall cumulative morbidity (sigmoidectomy 28/39 (72%) versus lavage 32/38 (84%), p = 0·272) and mortality (sigmoidectomy 7/39 (18%) versus lavage 6/38 (16%), p = 1·000) did not differ. The number of patients who underwent a reoperation was significantly lower for lavage compared to sigmoidectomy (sigmoidectomy 27/39 (69%) versus lavage 17/38 (45%), p = 0·039). After 36 months, patients alive with stoma in situ was lower in the lavage group (proportion calculated from the Kaplan–Meier life table, sigmoidectomy 17% vs lavage 11%, log-rank p = 0·0268). Eventually, 17 of 38 (45%) patients allocated to lavage underwent sigmoidectomy.ConclusionLong-term outcomes showed that laparoscopic lavage was associated with less patients who underwent reoperations and lower stoma rates in patients alive after 36 months compared to sigmoidectomy. No differences were found in terms of cumulative morbidity or mortality. Patient selection should be improved to reduce risk for short-term complications after which lavage could still be a valuable treatment option.Graphical abstract

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