Norman Galbraith1, Jane V Carter1, Uri Netz1,2, Dongyan Yang3, Donald E Fry4,5,6, Michael McCafferty7, Susan Galandiuk8. 1. Price Institute of Surgical Research, The Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, 40292, USA. 2. Department of Surgery, Soroka University Medical Center, Beer Sheva, Israel. 3. Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, 40202, USA. 4. Clinical Outcomes Management, MPA Healthcare Solutions, 1 East Wacker Drive, no. 1210, Chicago, IL, 60601, USA. 5. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA. 6. Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA. 7. Robley Rex Veterans Administration Medical Center, Louisville, KY, 40206, USA. 8. Price Institute of Surgical Research, The Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, 40292, USA. s0gala01@louisville.edu.
Abstract
IMPORTANCE: Perforated diverticulitis carries the risk of significant comorbidity and mortality. Although colon resection provides adequate source control, the procedure itself carries morbidity, as well as later stoma reversal procedures. The effectiveness of laparoscopic lavage to treat perforated diverticulitis remains unclear. OBJECTIVE: We aimed to conduct a meta-analysis to evaluate current studies comparing laparoscopic lavage with colon resection in cases of perforated diverticulitis for the effectiveness in source control, without the need for subsequent interventions, stoma formation, and death. DATA SOURCES: Electronic database searches were conducted using EMBASE, Pubmed, CINAHL, Cochrane databases, and clinicaltrials.gov following PRISMA guidelines. STUDY SELECTION: Randomized controlled trials (RCTs) were included that compared laparoscopic lavage against colon resection for perforated diverticulitis. DATA EXTRACTION AND SYNTHESIS: Risk of bias in RCT's was assessed the Cochrane Assessment of Bias risk tool and Jadad scale. A meta-analysis was performed using random-effects risk ratios (RR) and 95% confidence intervals (CI). MAIN OUTCOME: Outcome measures included the total rate of reoperation, rate of reoperation for infection, need for subsequent percutaneous drainage, stoma formation, and mortality rate within 90 days. RESULTS: Three eligible randomized controlled studies were identified, with a combined total of 372 patients. Laparoscopic lavage carried an increased rate of total reoperations (RR 2.07; CI 1.12-3.84; p = 0.021) and an increased rate of reoperation for infection (RR 5.56; CI 1.97-15.69; p = 0.001) compared with colon resection. In addition, laparoscopic lavage increased the rate of subsequent percutaneous drainage (RR 6.54; CI 1.77-24.16; p = 0.005) compared with colon resection, but a lesser risk of stoma formation within 90 days (RR 0.18; CI 0.12-0.27; p < 0.001). No difference in mortality rate was observed between treatments (RR 1.03; CI 0.45-2.34; p = 0.950). CONCLUSION: Despite decreased rates of stoma formation and equivalent mortality rates as compared with colon resection, laparoscopic lavage for Hinchey III diverticulitis fails to completely control the source of infection. Our data show that laparoscopic lavage is associated with increased rates of total reoperations, increased rates of reoperation for infections, and need for subsequent percutaneous drainage.
IMPORTANCE: Perforated diverticulitis carries the risk of significant comorbidity and mortality. Although colon resection provides adequate source control, the procedure itself carries morbidity, as well as later stoma reversal procedures. The effectiveness of laparoscopic lavage to treat perforated diverticulitis remains unclear. OBJECTIVE: We aimed to conduct a meta-analysis to evaluate current studies comparing laparoscopic lavage with colon resection in cases of perforated diverticulitis for the effectiveness in source control, without the need for subsequent interventions, stoma formation, and death. DATA SOURCES: Electronic database searches were conducted using EMBASE, Pubmed, CINAHL, Cochrane databases, and clinicaltrials.gov following PRISMA guidelines. STUDY SELECTION: Randomized controlled trials (RCTs) were included that compared laparoscopic lavage against colon resection for perforated diverticulitis. DATA EXTRACTION AND SYNTHESIS: Risk of bias in RCT's was assessed the Cochrane Assessment of Bias risk tool and Jadad scale. A meta-analysis was performed using random-effects risk ratios (RR) and 95% confidence intervals (CI). MAIN OUTCOME: Outcome measures included the total rate of reoperation, rate of reoperation for infection, need for subsequent percutaneous drainage, stoma formation, and mortality rate within 90 days. RESULTS: Three eligible randomized controlled studies were identified, with a combined total of 372 patients. Laparoscopic lavage carried an increased rate of total reoperations (RR 2.07; CI 1.12-3.84; p = 0.021) and an increased rate of reoperation for infection (RR 5.56; CI 1.97-15.69; p = 0.001) compared with colon resection. In addition, laparoscopic lavage increased the rate of subsequent percutaneous drainage (RR 6.54; CI 1.77-24.16; p = 0.005) compared with colon resection, but a lesser risk of stoma formation within 90 days (RR 0.18; CI 0.12-0.27; p < 0.001). No difference in mortality rate was observed between treatments (RR 1.03; CI 0.45-2.34; p = 0.950). CONCLUSION: Despite decreased rates of stoma formation and equivalent mortality rates as compared with colon resection, laparoscopic lavage for Hinchey III diverticulitis fails to completely control the source of infection. Our data show that laparoscopic lavage is associated with increased rates of total reoperations, increased rates of reoperation for infections, and need for subsequent percutaneous drainage.
Authors: Ian M Paquette; Patrick Solan; Janice F Rafferty; Martha A Ferguson; Bradley R Davis Journal: Dis Colon Rectum Date: 2013-08 Impact factor: 4.585
Authors: Daniël P V Lambrichts; Arianna Birindelli; Valeria Tonini; Roberto Cirocchi; Maurizio Cervellera; Johan F Lange; Willem A Bemelman; Salomone Di Saverio Journal: Inflamm Intest Dis Date: 2018-02-16
Authors: A Kohl; J Rosenberg; D Bock; T Bisgaard; S Skullman; A Thornell; J Gehrman; E Angenete; E Haglind Journal: Br J Surg Date: 2018-04-16 Impact factor: 6.939
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