Laparoscopic lavage for perforated diverticulitis in the LapLav study: population-based registry study

Samuelsson, Andreas; Bock, David; Prytz, Mattias; Block, Mattias; Ehrencrona, Carolina; Wedin, Anette; Ahlstedt, M; Angenete, Eva; Haglind, Eva

doi:10.1093/bjs/znab211

Cited by 6 publications

(14 citation statements)

References 23 publications

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“…Lastly, there was variability in the definitions and reporting of outcome data and the lack of standardised protocols for LL for Hinchey III diverticulitis. For example, there was substantial variation in the volume of normal saline used for irrigation between 4 and 15 litres, the number and positions of drains, and the duration of use of antibiotics [11][12][13][14][15][16][17][18][19][20][21][22]. In addition, due to the lack of outcome data, it was also not known whether patients in the CR group who had wound complications had a laparoscopic or open CR, which may affect the outcome data for wound infection when compared to LL.…”

Section: Discussionmentioning

confidence: 99%

“…Seventeen studies were excluded as they did not present comparative data for LL and CR. Of the 13 studies included in the meta-analysis [11][12][13][14][15][16][17][18][19][20][21][22][23], seven examined data from three RCTs at different time points of follow-up, and six were NRCSs (Table 1).…”

Section: Description Of Eligible Studiesmentioning

confidence: 99%

“…Based on the MINORS tool, the quality assessment scores for the six NRCSs [18][19][20][21][22][23] ranged from 10 to 21 (Table 2). The majority of the studies had clearly stated aims, included all participants within the study period and examined relevant endpoints to the study aims.…”

Section: Figure 2: Cochrane Risk-of-bias 2 Assessment Of Randomised C...mentioning

confidence: 99%

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A Meta-Analysis of Short-Term Outcomes After Laparoscopic Lavage Versus Colonic Resection in the Treatment of Perforated Diverticulitis

Tiong¹,

Chen²,

Phakey³

et al. 2023

Cureus

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The management of perforated non-faeculent diverticulitis has traditionally involved performing a colonic resection (CR). Laparoscopic lavage (LL) has emerged as a less invasive alternative in recent years. The aim of this meta-analysis was to assess the role of LL in the surgical treatment of perforated non-faeculent diverticulitis. To that end, we conducted a search on Embase, Medline, and Cochrane databases for comparative studies in the English language published till June 2021 [PROSPERO (CRD42021269410)]. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomised trials (RoB 2) and the methodological index for non-randomised studies (MINORS). Data were analysed using Cochrane RevMan. Pooled odds ratio (POR) and cumulative weighted ratios (CWR) were calculated.A total of 13 studies involving 1061 patients were found eligible, including seven studies based on three randomised control trials (RCTs). LL was associated with a reduced risk of wound infection, stoma formation, and need for further surgery by 77% [POR: 0.23, 95% confidence interval (CI): 0.07-0.74], 83% (POR: 0.17, 95% CI: 0.05-0.56), and 53% (POR: 0.47, 95% CI: 0.23-0.97) respectively. Duration of surgery and hospitalisation was reduced by 54% and 43% respectively. However, LL was associated with higher rates of unplanned reoperations (

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Section: Discussionmentioning

confidence: 99%

Section: Description Of Eligible Studiesmentioning

confidence: 99%

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A Meta-Analysis of Short-Term Outcomes After Laparoscopic Lavage Versus Colonic Resection in the Treatment of Perforated Diverticulitis

Tiong¹,

Chen²,

Phakey³

et al. 2023

Cureus

View full text Add to dashboard Cite

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“…When the surgery notes were found to be unclear on this point, the senior author read them separately and had the final decision. The study population and overall design have been described previously [ 12 ]. The report adheres to the STROBE statement.…”

Section: Methodsmentioning

confidence: 99%

“…In the reporting of the primary outcome, there were a total of 140 and 265 evaluable patients in the laparoscopic lavage and resection groups, respectively [ 12 ]. Assuming a response rate of 75% for the questionnaire, 105 and 199 patients were projected to have evaluable data, respectively.…”

Section: Methodsmentioning

confidence: 99%

Functional Outcomes of Emergency Surgery for Perforated Diverticulitis, Hinchey Grade III

et al. 2023

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Background Laparoscopic lavage as a treatment for perforated diverticulitis, Hinchey III, has been found safe and feasible in randomized trials. A few studies have reported functional outcomes and quality of life as secondary outcomes. This study investigated distress associated with dysfunction of the bowel or stoma, functional outcomes, and quality of life 2–3 years after surgery in a national unselected cohort. Methods All patients in Sweden who underwent emergency surgery for perforated diverticulitis with purulent peritonitis (2016–2018) were invited to answer a comprehensive, study-specific questionnaire 2–3 years after the index surgery. Results Out of 499 potential patients, 226 returned the questionnaire, and 209 were included in the analysis. There was no statistically significant difference between laparoscopic lavage and resection in distress associated with dysfunction of the bowel or stoma (odds ratio [OR], 1.32 [95% CI, 0.91–1.92]; p = 0.015). Bowel dysfunction measured by the LARS score was significantly higher for the lavage group (OR, 1.65 [95% CI, 1.11–2.45]), while stoma was more frequent after resection surgery (40 vs 6%). Conclusions Patients experienced long-term distress from bodily dysfunction after emergency surgery for perforated diverticulitis regardless of the technique used. Regular follow-up could benefit these patients. Trial Registration The project was registered at ClinicalTrials.gov on 2017–11-06. Identifier: NCT03332550. Acronym: LapLav.

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

et al. 2022

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Background This 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. Methods Within 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. Results Long-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. Conclusion Long-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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Laparoscopic lavage for perforated diverticulitis in the LapLav study: population-based registry study

Cited by 6 publications

References 23 publications

A Meta-Analysis of Short-Term Outcomes After Laparoscopic Lavage Versus Colonic Resection in the Treatment of Perforated Diverticulitis

A Meta-Analysis of Short-Term Outcomes After Laparoscopic Lavage Versus Colonic Resection in the Treatment of Perforated Diverticulitis

Functional Outcomes of Emergency Surgery for Perforated Diverticulitis, Hinchey Grade III

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

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