BACKGROUND: Over the past few years, the laparoscopic peritoneal lavage has emerged as a therapeutic alternative to standard resection procedures. However, its effectiveness and applicability remain debatable. OBJECTIVE: The aim of this study was to assess laparoscopic lavage in controlling abdominal sepsis secondary to purulent peritonitis. DESIGN: This study was conducted as a retrospective analysis of prospectively collected data. SETTING: This study was conducted at a single tertiary care institution. PATIENTS: Patients requiring emergency surgery for perforated diverticulitis and generalized peritonitis between June 2006 and June 2013 were identified from a prospective database. Laparoscopic assessment was considered in all of the hemodynamically stable patients, and laparoscopic lavage was performed according to intraoperative strict criteria. MAIN OUTCOME MEASURES: Primary outcomes were the effectiveness and applicability of laparoscopic lavage. Secondarily, feasibility, morbidity, and mortality were also assessed. RESULTS: Seventy-five patients required emergency surgery for generalized peritonitis secondary to perforated diverticulitis. Forty-six patients who underwent laparoscopy presented a purulent generalized (Hinchey III) peritonitis and were examined under the intention-to-treat basis to perform a laparoscopic lavage. Thirty-two patients (70.0%; 95% CI 56.2-82.7) had no previous episodes of diverticulitis. Thirty-six patients (78.0%; 95% CI 66.3-90.1) had free air on a CT scan. The conversion rate was 4% (95% CI 0-10). The feasibility of the method was 96.0% (95% CI 90.4-100), and its applicability was 59.0% (95% CI 44.8-73.2). Median operative time was 89 minutes (range, 40-200 minutes). Postoperative morbidity was 24.0% (95% CI 11.7-36.3), and the mortality rate was 0%. We registered 5 failures, and all of them underwent reoperation. The effectiveness of the procedure was 85% (95% CI 76-93). LIMITATIONS: This was a single-institution retrospective study. CONCLUSIONS: The effectiveness of laparoscopic lavage seems to be high. Although its applicability is lower, it could be applied in more than half of patients requiring emergency surgery. This alternative strategy should be considered when laparoscopic assessment reveals Hinchey III diverticulitis.
BACKGROUND: Over the past few years, the laparoscopic peritoneal lavage has emerged as a therapeutic alternative to standard resection procedures. However, its effectiveness and applicability remain debatable. OBJECTIVE: The aim of this study was to assess laparoscopic lavage in controlling abdominal sepsis secondary to purulent peritonitis. DESIGN: This study was conducted as a retrospective analysis of prospectively collected data. SETTING: This study was conducted at a single tertiary care institution. PATIENTS: Patients requiring emergency surgery for perforated diverticulitis and generalized peritonitis between June 2006 and June 2013 were identified from a prospective database. Laparoscopic assessment was considered in all of the hemodynamically stable patients, and laparoscopic lavage was performed according to intraoperative strict criteria. MAIN OUTCOME MEASURES: Primary outcomes were the effectiveness and applicability of laparoscopic lavage. Secondarily, feasibility, morbidity, and mortality were also assessed. RESULTS: Seventy-five patients required emergency surgery for generalized peritonitis secondary to perforated diverticulitis. Forty-six patients who underwent laparoscopy presented a purulent generalized (Hinchey III) peritonitis and were examined under the intention-to-treat basis to perform a laparoscopic lavage. Thirty-two patients (70.0%; 95% CI 56.2-82.7) had no previous episodes of diverticulitis. Thirty-six patients (78.0%; 95% CI 66.3-90.1) had free air on a CT scan. The conversion rate was 4% (95% CI 0-10). The feasibility of the method was 96.0% (95% CI 90.4-100), and its applicability was 59.0% (95% CI 44.8-73.2). Median operative time was 89 minutes (range, 40-200 minutes). Postoperative morbidity was 24.0% (95% CI 11.7-36.3), and the mortality rate was 0%. We registered 5 failures, and all of them underwent reoperation. The effectiveness of the procedure was 85% (95% CI 76-93). LIMITATIONS: This was a single-institution retrospective study. CONCLUSIONS: The effectiveness of laparoscopic lavage seems to be high. Although its applicability is lower, it could be applied in more than half of patients requiring emergency surgery. This alternative strategy should be considered when laparoscopic assessment reveals Hinchey III diverticulitis.
Authors: Norman Galbraith; Jane V Carter; Uri Netz; Dongyan Yang; Donald E Fry; Michael McCafferty; Susan Galandiuk Journal: J Gastrointest Surg Date: 2017-06-12 Impact factor: 3.452
Authors: Massimo Sartelli; Frederick A Moore; Luca Ansaloni; Salomone Di Saverio; Federico Coccolini; Ewen A Griffiths; Raul Coimbra; Ferdinando Agresta; Boris Sakakushev; Carlos A Ordoñez; Fikri M Abu-Zidan; Aleksandar Karamarkovic; Goran Augustin; David Costa Navarro; Jan Ulrych; Zaza Demetrashvili; Renato B Melo; Sanjay Marwah; Sanoop K Zachariah; Imtiaz Wani; Vishal G Shelat; Jae Il Kim; Michael McFarlane; Tadaja Pintar; Miran Rems; Miklosh Bala; Offir Ben-Ishay; Carlos Augusto Gomes; Mario Paulo Faro; Gerson Alves Pereira; Marco Catani; Gianluca Baiocchi; Roberto Bini; Gabriele Anania; Ionut Negoi; Zurabs Kecbaja; Abdelkarim H Omari; Yunfeng Cui; Jakub Kenig; Norio Sato; Andras Vereczkei; Matej Skrovina; Koray Das; Giovanni Bellanova; Isidoro Di Carlo; Helmut A Segovia Lohse; Victor Kong; Kenneth Y Kok; Damien Massalou; Dmitry Smirnov; Mahir Gachabayov; Georgios Gkiokas; Athanasios Marinis; Charalampos Spyropoulos; Ioannis Nikolopoulos; Konstantinos Bouliaris; Jaan Tepp; Varut Lohsiriwat; Elif Çolak; Arda Isik; Daniel Rios-Cruz; Rodolfo Soto; Ashraf Abbas; Cristian Tranà; Emanuele Caproli; Darija Soldatenkova; Francesco Corcione; Diego Piazza; Fausto Catena Journal: World J Emerg Surg Date: 2015-02-19 Impact factor: 5.469
Authors: Massimo Sartelli; Fausto Catena; Luca Ansaloni; Federico Coccolini; Ewen A Griffiths; Fikri M Abu-Zidan; Salomone Di Saverio; Jan Ulrych; Yoram Kluger; Ofir Ben-Ishay; Frederick A Moore; Rao R Ivatury; Raul Coimbra; Andrew B Peitzman; Ari Leppaniemi; Gustavo P Fraga; Ronald V Maier; Osvaldo Chiara; Jeffry Kashuk; Boris Sakakushev; Dieter G Weber; Rifat Latifi; Walter Biffl; Miklosh Bala; Aleksandar Karamarkovic; Kenji Inaba; Carlos A Ordonez; Andreas Hecker; Goran Augustin; Zaza Demetrashvili; Renato Bessa Melo; Sanjay Marwah; Sanoop K Zachariah; Vishal G Shelat; Michael McFarlane; Miran Rems; Carlos Augusto Gomes; Mario Paulo Faro; Gerson Alves Pereira Júnior; Ionut Negoi; Yunfeng Cui; Norio Sato; Andras Vereczkei; Giovanni Bellanova; Arianna Birindelli; Isidoro Di Carlo; Kenneth Y Kok; Mahir Gachabayov; Georgios Gkiokas; Konstantinos Bouliaris; Elif Çolak; Arda Isik; Daniel Rios-Cruz; Rodolfo Soto; Ernest E Moore Journal: World J Emerg Surg Date: 2016-07-29 Impact factor: 5.469
Authors: Massimo Sartelli; Dieter G Weber; Yoram Kluger; Luca Ansaloni; Federico Coccolini; Fikri Abu-Zidan; Goran Augustin; Offir Ben-Ishay; Walter L Biffl; Konstantinos Bouliaris; Rodolfo Catena; Marco Ceresoli; Osvaldo Chiara; Massimo Chiarugi; Raul Coimbra; Francesco Cortese; Yunfeng Cui; Dimitris Damaskos; Gian Luigi De' Angelis; Samir Delibegovic; Zaza Demetrashvili; Belinda De Simone; Francesco Di Marzo; Salomone Di Saverio; Therese M Duane; Mario Paulo Faro; Gustavo P Fraga; George Gkiokas; Carlos Augusto Gomes; Timothy C Hardcastle; Andreas Hecker; Aleksandar Karamarkovic; Jeffry Kashuk; Vladimir Khokha; Andrew W Kirkpatrick; Kenneth Y Y Kok; Kenji Inaba; Arda Isik; Francesco M Labricciosa; Rifat Latifi; Ari Leppäniemi; Andrey Litvin; John E Mazuski; Ronald V Maier; Sanjay Marwah; Michael McFarlane; Ernest E Moore; Frederick A Moore; Ionut Negoi; Leonardo Pagani; Kemal Rasa; Ines Rubio-Perez; Boris Sakakushev; Norio Sato; Gabriele Sganga; Walter Siquini; Antonio Tarasconi; Matti Tolonen; Jan Ulrych; Sannop K Zachariah; Fausto Catena Journal: World J Emerg Surg Date: 2020-05-07 Impact factor: 5.469
Authors: Vincent T Hoek; Pim P Edomskis; Pieter W Stark; Daniel P V Lambrichts; Werner A Draaisma; Esther C J Consten; Johan F Lange; Willem A Bemelman Journal: Surg Endosc Date: 2022-05-23 Impact factor: 3.453