Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 10/2012

01-10-2012

Damage control strategy for the management of perforated diverticulitis with generalized peritonitis: laparoscopic lavage and drainage vs. laparoscopic Hartmann’s procedure

Authors: Song Liang, Karla Russek, Morris E. Franklin Jr.

Published in: Surgical Endoscopy | Issue 10/2012

Login to get access

Abstract

Background

This study was designed to compare laparoscopic peritoneal lavage and drainage (LLD) with laparoscopic Hartmann’s procedure (LHP) in the management of perforated diverticulitis and to investigate a safer and more effective laparoscopic method for managing acute perforated diverticulitis with generalized peritonitis.

Methods

A consecutive series of patients who underwent emergent LHP or LLD for perforated diverticulitis were identified from a prospectively designed database. All procedure-related information was collected and analyzed. P < 5 % was considered statistically significant in this study.

Results

A total of 88 patients underwent emergent laparoscopic procedures (47 LLD and 41 LHP) between 1995 and 2010 for acute perforated diverticulitis. Diagnostic laparoscopy classified 74 (84.1 %) patients as Hinchey III or IV perforated diverticulitis. OT for LHP was 182 ± 54.7 min, and EBL was 210 ± 170.5 ml. Six LHP (14.6 %) were converted to open Hartmann’s for various reasons. Moreover the rates of LHP-associated postoperative mortality and morbidity were 2.4 and 17.1 %, respectively. For LLD, the operating time was 99.7 ± 39.8 min, and blood loss was 34.4 ± 21.2 ml. Three patients (6.4 %) were reoperated for the worsening of septic symptoms during post-LLD course. Moreover, the patients with LHP had significantly longer hospital stay than the ones with LLD did (16.3 ± 10.1 vs. 6.7 ± 2.2 days, P < 0.01). In the long-term follow-up, the rate of colostomy closure for LHP is 72.2 %, and 21 of 47 patients who underwent LLD had elective sigmoidectomy for the source control with the rate of 44.7 %.

Conclusions

Both LHP and LLD can be performed safely and effectively for managing severe diverticulitis with generalized peritonitis. Compared with LHP, LLD does not remove the pathogenic source; however, the clinical application of this damage control operation to our patients showed significantly better short- and long-term clinical outcomes for managing perforated diverticulitis with various Hinchey classifications.
Literature
1.
Parks TG (1975) Natural history of diverticular disease of the colon. Clin Gastroenterol 4:53–69PubMed
2.
Krukowski ZH, Matheson NA (1984) Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: a review. Br J Surg 71:921–927PubMedCrossRef
3.
Berry AR, Turner WH, Mortensen NJ, Kettlewell MG (1989) Emergency surgery for complicated diverticular disease: a five-year experience. Dis Colon Rectum 32:849–854PubMedCrossRef
4.
Salem L, Anaya DA, Flum DR (2005) Temporal changes in the management of diverticulitis. J Surg Res 124(2):318–323PubMedCrossRef
5.
Kronborg O (1993) Treatment of perforated sigmoid diverticulitis: a prospective randomized trial. Br J Surg 80:505–507PubMedCrossRef
6.
Khan AL, Ah-See AK, Crofts TJ, Heys SD, Eremin O (1995) Surgical management of the septic complications of diverticular disease. Ann R Coll Surg Engl 77:16–20PubMed
7.
Köhler L, Sauerland S, Neuebauer E (1999) Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery. Surg Endosc 13:430–436PubMedCrossRef
8.
Stollman NH, Raskin JB (1999) Diagnosis and management of diverticular disease of the colon in adults: Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 94:3110–3121PubMedCrossRef
9.
Salem L, Anaya DA, Roberts KE, Flum DR (2005) Hartmann’s colectomy and reversal in diverticulitis: a population-level assessment. Dis Colon Rectum 48:988–995PubMedCrossRef
10.
Seah DW, Ibrahim S, Tay KH (2005) Hartmann procedure: is it still relevant today? ANZ J Surg 75:436–440PubMedCrossRef
11.
Stawicki SP, Brooks A, Bilski T, Scaff D, Gupta R, Schwab CW, Gracias VH (2008) The concept of damage control: extending the paradigm to emergency general surgery. Injury 39(1):93–101PubMedCrossRef
12.
Parra-Blanco A (2006) Colonic diverticular disease: pathophysiology and clinical picture. Digestion 73(Suppl 1):47–57PubMedCrossRef
13.
Rotondo M, Schwab CW, McGonigal M, Phillips G, Fruchterman T, Kauder D, Latenser B, Angood P (1993) Damage control: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 35:373–383
14.
O’Sullivan GC, Murphy D, O’Brien MG, Ireland A (1996) Laparoscopic management of generalized peritonitis due to perforated colonic diverticula. Am J Surg 171:432–434PubMedCrossRef
15.
Stocchi L (2010) Current indications and role of surgery in the management of sigmoid diverticulitis. World J Surg 16(7):804–817
16.
Myers E, Hurley M, O’Sullivan GC, Kavanagh D, Wilson I, Winter DC (2008) Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 95:97–101PubMedCrossRef
17.
Santaniello M, Bergamaschi R (2006) Perforated diverticulitis: should the method of surgical access to the abdomen determine treatment? Colorectal Dis 9:494–495CrossRef
18.
Murphy T, Hunt RH, Fried M, Krabshuis JH (2007) World Gastroenterology Organisation Practice Guidelines: diverticular disease. WGO guidelines@worldgastroenterology.org. Accessed 12 Dec 2011
19.
Scholefield JH, Wyman A, Rogers K (1991) Management of generalized faecal peritonitis–can we do better. J R Soc Med 84:664–666PubMed
20.
Schwesinger WH, Page CP, Gaskill HV 3rd, Steward RM, Chopra S, Strodel WE, Sirinek KR (2000) Operative management of diverticular emergencies. Strategies and outcomes. Arch Surg 135:558–563PubMedCrossRef
21.
Vermeulen J, Lange JF (2010) Treatment of perforated diverticulitis with generalized peritonitis: past, present, and future. World J Surg 34(3):587–593PubMedCrossRef
22.
Hinchey EJ, Schaal PG, Richards GK (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109PubMed
23.
Durmishi Y, Gervaz P, Brandt D, Bucher P, Platon A, Morel P, Poletti PA (2006) Results from percutaneous drainage of Hinchey II diverticulitis guided by computed tomography scan. Surg Endosc 20:1129–1133PubMedCrossRef
24.
Christou NV, Barie PS, Dellinger EP, Waymack JP, Stone HH (1993) Surgical Infection Society intra-abdominal infection study. Prospective evaluation of management techniques and outcome. Arch Surg 128:193–198PubMedCrossRef
25.
Hau T, Ohmann C, Wolmershäuser A, Wacha H, Yang Q (1995) Peritonitis Study Group of the Surgical Infection Society Europe. Planned relaparotomy vs. relaparotomy on demand in the treatment of intra-abdominal infections. Arch Surg 130:1193–1197PubMedCrossRef
26.
27.
Wittmann DH (1998) Operative and nonoperative therapy of intraabdominal infections. Infection 26:335–341PubMedCrossRef
28.
Desai DC, Brennan EJ Jr, Reilly JF, Smink RD Jr (1998) The utility of the Hartmann procedure. Am J Surg 175:152–154PubMedCrossRef
29.
Faranda C, Barrat C, Catheline JM, Champault GG (2000) Two-stage laparoscopic management of generalized peritonitis due to perforated sigmoid diverticula: eighteen cases. Surg Laparosc Endosc Percutan Tech 10:135–138PubMed
30.
The Standards Task Force, The American Society of Colon and Rectal Surgeons (2000) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 43:289–297CrossRef
31.
Gooszen AW, Tollenaar RA, Geelkerken RH, Smeets HJ, Bemelman WA, Van Schaardenburgh P, Gooszen HG (2001) Prospective study of primary anastomosis following sigmoid resection for suspected acute complicated diverticular disease. Br J Surg 88:693–697PubMedCrossRef
32.
Regenet N, Tuech JJ, Pessaux P, Ziani M, Rouge C, Hennekinne S, Arnaud JP (2002) Angers CHU: intraoperative colonic lavage with primary anastomosis vs. Hartmann’s procedure for perforated diverticular disease of the colon: a consecutive study. Hepatogastroenterology 49:664–667PubMed
33.
Seetharam S, Paige J, Horgan PG (2003) Impact of socioeconomic deprivation and primary pathology on rate of reversal of Hartmann’s procedure. Am J Surg 186:154–157PubMedCrossRef
34.
Maggard MA, Zingmond D, O’Connell JB, Ko CY (2004) What proportion of patients with an ostomy (for diverticulitis) get reversed? Am Surg 70:928–931PubMed
35.
Salem L, Flum DR (2004) Primary anastomosis or Hartmann’s procedure for patients with diverticular peritonitis? A systematic review. Dis Colon Rectum 47:1953–1964PubMedCrossRef
36.
Banerjee S, Leather AJ, Rennie JA, Samano N, Gonzalez JG, Papagrigoriadis S (2005) Feasibility and morbidity of reversal of Hartmann’s. Colorectal Dis 7:454–459PubMedCrossRef
37.
Chapman J, Davies M, Wolff B, Dozois E, Tessier D, Harrington J, Larson D (2005) Complicated diverticulitis: is it time to rethink the rules? Ann Surg 242:576–581PubMed
38.
39.
Franklin ME Jr, Dorman JP, Jacobs M, Plasencia G (1997) Is laparoscopic surgery applicable to complicated colonic diverticular disease? Surg Endosc 11:1021–1025PubMedCrossRef
40.
Mutter D, Bouras G, Forgione A, Vix M, Leroy J, Marescaux J (2006) Two-stage totally minimally invasive approach for acute complicated diverticulitis. Colorectal Dis 8:501–505PubMedCrossRef
41.
Chouillard E, Maggiori L, Ata T, Jarbaoui S, Rivkine E, Benhaim L, Ghiles E, Etienne JC, Fingerhut A (2007) Laparoscopic two-stage left colonic resection for patients with peritonitis caused by acute diverticulitis. Dis Colon Rectum 50:1157–1163PubMedCrossRef
42.
Agaba EA, Zaidi RM, Ramzy P, Aftab M, Rubach E, Gecelter G, Ravikumar TS, DeNoto G (2009) Laparoscopic Hartmann’s procedure: a viable option for treatment of acutely perforated diverticulitis. Surg Endosc 23:1483–1486PubMedCrossRef
43.
Bretagnol F, Pautrat K, Mor C, Benchellal Z, Huten N, de Calan L (2008) Emergency laparoscopic management of perforated sigmoid diverticulitis: a promising alternative to more radical procedure. J Am Coll Surg 206:654–657PubMedCrossRef
44.
Franklin ME Jr, Portillo G, Trevin˜o JM, Gonzalez JJ, Glass JL (2008) Long-term experience with the laparoscopic approach to perforated diverticulitis plus generalized peritonitis. World J Surg 32:1507–1511PubMedCrossRef
45.
Alamili M, Gogenur I, Rosenberg J (2009) Acute complicated diverticulitis managed by laparoscopic lavage. Dis Colon Rectum 52:1345–1349PubMedCrossRef
46.
Toorenvliet BR, Swank H, Schoones JW, Hamming JF, Bemelman WA (2010) Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a systematic review. Colorectal Dis 12:862–867PubMedCrossRef
47.
Carrillo C, Fogler R, Shaftan G (1993) Delayed gastrointestinal reconstruction following massive abdominal trauma. J Trauma 34:233–235PubMedCrossRef
48.
Surface ship survivability. Naval War Publications 3–20.31 (1996). Department of Defense, Washington, DC
49.
Moore EE, Burch JM, Franciose RJ, Offner PJ, Biffl WL (1998) Staged physiologic restoration and damage control surgery. World J Surg 22(12):1184–1190PubMedCrossRef
50.
Shapiro MB, Jenkins DH, Schwab CW, Rotondo MF (2000) Damage control: collective review. J Trauma 49:969–978PubMedCrossRef
51.
Person B, Dorfman T, Bahouth H, Osman A, Assalia A, Kluger Y (2009) Abbreviated emergency laparotomy in the non-trauma setting. World J Emerg Surg 4:41–44PubMedCrossRef
52.
Jansen JO, Loudon MA (2007) Damage control surgery in a non-trauma setting. Br J Surg 94(7):789–790PubMedCrossRef
53.
Burch JM, Denton JR, Noble RD (1997) Physiologic rationale for abbreviated laparotomy. Surg Clin North Am 77(4):779–782PubMedCrossRef
54.
Miller PR, Chang MC, Hoth JJ, Holmes JH, Meredith JW (2007) Colonic resection in the setting of damage control laparotomy: is delayed anastomosis safe? Am Surg 73(6):606–609PubMed
55.
Van Goor H (2002) Interventional management of abdominal sepsis: when and how? Langenbecks Arch Surg 387(5–6):191–200PubMedCrossRef
56.
van Ruler O, Mahler CW, Boer KR, Reuland EA, Gooszen HG, Opmeer BC, de Graaf PW, Lamme B, Gerhards MF, Steller EP, van Till JW, de Borgie CJ, Gouma DJ, Reitsma JB, Boermeester MA (2007) Comparison of on-demand vs. planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. Dutch Peritonitis Study Group. JAMA 298(8):865–872PubMedCrossRef
57.
Banieghbal B, Davies MR (2004) Damage control laparotomy for generalized necrotizing enterocolitis. World J Surg 28(2):183–186PubMedCrossRef
58.
Hau T, Ohmann C, Wolmershäuser A, Wacha H, Yang Q (1995) Planned relaparotomy vs. relaparotomy on demand in the treatment of intra-abdominal infections. The Peritonitis Study Group of the Surgical Infection Society-Europe. Arch Surg 130(11):1193–1196PubMedCrossRef
59.
Lamme B, Boermeester MA, Reitsma JB, Mahler CW, Obertop H, Gouma DJ (2002) Meta-analysis of relaparotomy for secondary peritonitis. Br J Surg 89(12):1516–1524PubMedCrossRef
60.
Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE (2003) Spectrum of disease and outcome of complicated diverticular disease. Am J Surg 186:696–701PubMedCrossRef
61.
Constantinides VA, Tekkis PP, Senapati A (2006) Prospective multicenter evaluation of adverse outcomes following treatment for complicated diverticular disease. Br J Surg 93:1503–1513PubMedCrossRef
62.
Taylor CJ, Layani L, Ghusn MA, White SI (2006) Perforated diverticulitis managed by laparoscopic lavage. ANZ J Surg 76:962–965PubMedCrossRef
63.
Killingback M (1983) Management of perforative diverticulitis. Surg Clin North Am 63:97–115PubMed
64.
Fry RD, Mahmoud NN (2007) Segmental resection for diverticulitis. In: Fischer JE, Bland KI (eds) Mastery of surgery, 5th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1516–1526
65.
66.
Constantinides VA, Heriot A, Remzi FH, Darzi A, Senapati A, Fazio VW, Tekkis PP (2007) Operative strategies for diverticular peritonitis: a decision analysis between primary resection and anastomosis versus Hartmann’s procedure. Ann Surg 245:94–103PubMedCrossRef
67.
Metadata
Title
Damage control strategy for the management of perforated diverticulitis with generalized peritonitis: laparoscopic lavage and drainage vs. laparoscopic Hartmann’s procedure
Authors
Song Liang
Karla Russek
Morris E. Franklin Jr.
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 10/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2255-y

Other articles of this Issue 10/2012

Surgical Endoscopy 10/2012 Go to the issue

Letter to the Editor--Reply

Reply to: doi:10.1007/s00464-012-2257-9: Endoscopic ultrasound-guided endoscopic necrosectomy of the pancreas: is irrigation necessary?

OriginalPaper

Plasma levels of angiopoietin-like protein 4 (ANGPTL4) are significantly lower preoperatively in colorectal cancer patients than in cancer-free patients and are further decreased during the first month after minimally invasive colorectal resection

OriginalPaper

Laparoscopic versus robotic subtotal splenectomy in hereditary spherocytosis. Potential advantages and limits of an expensive approach

OriginalPaper

Laparoscopic splenectomy: experience of a single center in a series of 300 cases

OriginalPaper

Low impact of staging EUS for determining surgical resectability in esophageal cancer

OriginalPaper

A comparative study of surgery and endoscopy for the treatment of bile duct stricture in patients with chronic pancreatitis