Multicentre international trial of laparoscopic lavage for Hinchey III acute diverticulitis (LLO Study)

Binda, Gian Andrea; Bonino, Marco Augusto; Siri, Giacomo; Saverio, Salomone Di; Rossi, Gustavo; Nascimbeni, Riccardo; Sorrentino, M.; Arezzo, Alberto; Vettoretto, Nereo; Cirocchi, Roberto; Birindelli, Arianna; Bertone, Santiago; Mentz, Ricardo; Brizzolari, Marco; Galleano, Raffaele; Reggiani, L; Parisi, Amilcare; Gemini, Alessandro; Pascariello, A.; Boccia, Luigi; Capelli, Patrizio; Pertile, Davide; Baldazzi, Giànandrea; Cassini, Diletta; Portale, Giuseppe; Fiscon, Valentino; Boselli, Carlo; Gervaz, Pascal; Gomes, Carlos Augusto; Horesh, Nir; Valcárcel, Cristina Rey; Battocletti, Mario; Guercioni, Gianluca; Tonini, Valeria; Agresta, Ferdinando; Bisagni, Pietro; Crucitti, Antonio; Mariani, Paul; Casiraghi, Silvia; Lakkis, Zaher

doi:10.1002/bjs.10916

Cited by 37 publications

(38 citation statements)

References 35 publications

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“…Considering the additional events during long‐term follow‐up, both high ASA scores (≥ 3) and the presence of two or more comorbidities, regardless of their nature or treatment, were associated with an unfavourable prognosis. This is largely in accordance with two previous studies identifying risk factors for the failure of LL . Due to the relatively small sample size, multivariate analysis was not performed in this study.…”

Section: Discussionsupporting

confidence: 89%

“…The sigmoidectomy rate reported at 2‐year follow‐up in the DILALA trial was 21% ( n = 43) . In the recently published LLO Study, the overall reoperation rate was 26% (56/212 patients) . Furthermore, the recurrence rate was 27% (47/172 patients) in patients without re‐interventions during admission and the first 60 postoperative days.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, accurate selection of patients that might benefit from this treatment is of importance to obtain satisfactory results, e.g. by taking age, immunosuppression, severe comorbidities (ASA ≥ 3), mannheim peritonitis index and history of acute diverticulitis into consideration . Long‐term follow‐up of other randomized controlled trials comparing LL to sigmoidectomy will provide more data on the efficacy and cost‐effectiveness, as well as other studies assessing potential risk factors of treatment failure, and might help to improve accurate patient selection for LL.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term follow‐up of a multicentre cohort study on laparoscopic peritoneal lavage for perforated diverticulitis

et al. 2019

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AimLaparoscopic peritoneal lavage has increasingly been investigated as a promising alternative to sigmoidectomy for perforated diverticulitis with purulent peritonitis. Most studies only reported outcomes up to 12 months. Therefore, the objective of this study was to evaluate long‐term outcomes of patients treated with laparoscopic lavage.MethodsBetween 2008 and 2010, 38 patients treated with laparoscopic lavage for perforated diverticulitis in 10 Dutch teaching hospitals were included. Long‐term follow‐up data on patient outcomes, e.g. diverticulitis recurrence, reoperations and readmissions, were collected retrospectively. The characteristics of patients with recurrent diverticulitis or complications requiring surgery or leading to death, categorized as ‘overall complicated outcome’, were compared with patients who developed no complications or complications not requiring surgery.ResultsThe median follow‐up was 46 months (interquartile range 7–77), during which 17 episodes of recurrent diverticulitis (seven complicated) in 12 patients (32%) occurred. Twelve patients (32%) required additional surgery with a total of 29 procedures. Fifteen patients (39%) had a total of 50 readmissions. Of initially successfully treated patients (n = 31), 12 (31%) had recurrent diverticulitis or other complications. At 90 days, 32 (84%) patients were alive without undergoing a sigmoidectomy. However, seven (22%) of these patients eventually had a sigmoidectomy after 90 days. Diverticulitis‐related events occurred up to 6 years after the index procedure.ConclusionLong‐term diverticulitis recurrence, re‐intervention and readmission rates after laparoscopic lavage were high. A complicated outcome was also seen in patients who had initially been treated successfully with laparoscopic lavage with relevant events occurring up to 6 years after initial surgery.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long‐term follow‐up of a multicentre cohort study on laparoscopic peritoneal lavage for perforated diverticulitis

et al. 2019

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“…Several meta-analyses have been performed with somewhat different results [125][126][127][128][129][130][131][132][133]. There are several noncomparative cohorts showing that laparoscopic lavage is feasible in selected patients [134]. Laparoscopic lavage reduces the risk for colostomy at 1-and 2-year follow-up but may in the short term result in intra-abdominal abscesses and overlooked free perforations or tumour perforations requiring reintervention (drainage or reoperation) [135,136].…”

Section: Which Surgical Approach Is Appropriate In Patients With Purumentioning

confidence: 99%

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Schultz

Azhar

Binda³

et al. 2020

Colorectal Disease

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168

214

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Aim The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons. Methods The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements. Results This guideline contains 38 evidence based consensus statements on the management of diverticular disease. Conclusion This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.

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“…LPL can avoid stoma creation in up to 38% to 51% of cases; the 12-month stoma-free rate is an important patient-centered outcome. Today, LPL for Hinchey III should be performed predominantly in clinical studies [46,47].…”

Section: Immunocompromised Patientsmentioning

confidence: 99%

Hot Topics in Surgical Management of Acute Diverticulitiss

Binda

Papa

Persiani

et al. 2020

JGLD

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In this session different issues for the surgical management of diverticular disease DD) were considered. The first session debated about the antibiotic treatment for acute uncomplicated diverticulitis (AUD), and supports their use selectively rather than routinely in patients with AUD. The second session discussed the best surgical treatment for those patients. Open approach is a valid choice especially in acute setting, while the laparoscopic approach should be individualised according to the level of skills of the surgeon and the risk factors of the patient (such as obesity and state of health at the time of the operation). The third session debated about the peritoneal lavage and drainage, which is still a safe surgical procedure. However, it requires longer follow-up and results of other trials to draw an adequate conclusion. The last session covers the current surgical certainties in managing complicated DD: 1. urgent colectomy has higher mortality in immune-compromised patients, while in elective surgery is comparable with other populations; 2. laparoscopic peritoneal lavage (LPL) should be the choice in young/fit patients; 3. elective resection is safer in an inflammation free interval; 4. laparoscopic resection shows advantages in several outcomes (such as post-operative morbidity and lower stoma and re-operation rate); 5. in Hinchey III/fecal peritonitis, primary sigmoid resection and anastomosis (open or laparoscopic) could be proposed in young/ fit patient; 6. in case of emergency surgery, Hartmann procedure (open or laparoscopic) must be considered in critically ill/unstable patient.

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Multicentre international trial of laparoscopic lavage for Hinchey III acute diverticulitis (LLO Study)

Abstract: Laparoscopic lavage showed a high rate of successful sepsis control in selected patients with perforated Hinchey III acute diverticulitis affected by peritonitis, with low rates of operative mortality, reoperation and stoma formation.

Cited by 37 publications

References 35 publications

Long‐term follow‐up of a multicentre cohort study on laparoscopic peritoneal lavage for perforated diverticulitis

Long‐term follow‐up of a multicentre cohort study on laparoscopic peritoneal lavage for perforated diverticulitis

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Hot Topics in Surgical Management of Acute Diverticulitiss

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