The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitisA and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitisB in perforated diverticulitis (NTR2037)

Swank, Hilko A; Vermeulen, Jefrey; Lange, Johan F.; Mulder, Irene M.; Hoeven, J. A. van der; Stassen, Laurents P. S.; Crolla, Rogier M. P. H.; Sosef, Meindert N.; Nienhuijs, Simon W.; Bosker, Robbert J. I.; Boom, Maarten J.; Kruyt, Philip M.; Swank, Dingeman J.; Steup, W. H.; Graaf, Eelco J. de; Weidema, W. F.; Pierik, Robert; Prins, Hubert A.; Stockmann, H. B. A. C.; Tollenaar, Rob A.E.M.; Wagensveld, Bart A. van; Coene, Peter-Paul; Slooter, Gerrit D.; Consten, Esther C. J.; Duijn, Eino B van; Gerhards, Michael F.; Hoofwijk, A. G. M.; Karsten, Thomas; Neijenhuis, Peter A.; Blanken-Peeters, C.F.J.M.; Cense, Huib A.; Mannaerts, G. H. H.; Bruin, Sjoerd C.; Eijsbouts, Q. A. J.; Wiezer, Marinus J.; Hazebroek, Eric J.; Geloven, Anna Aw van; Maring, John K.; D’Hoore, André; Kartheuser, Alex; Remue, Christophe; Grevenstein, Helma MU van; Konsten, J.; Peet, Donald L. van der; Govaert, Marc J. P. M.; Engel, Alexander; Reitsma, Johannes B.; Bemelman, Willem A.

doi:10.1186/1471-2482-10-29

Cited by 118 publications

(87 citation statements)

References 27 publications

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“…Also for complications after bowel surgery, lavage is suggested [8][9][10][11][12][13][14][15][16]. RCTs to confirm the beneficial effect of lavage in diverticulitis have been initiated in the Netherlands [23] and in Scandinavia. In gynaecology, lavage has become a standard practice for PID [24] and for pelvic abscesses [25].…”

Section: Discussionmentioning

confidence: 99%

Extensive peritoneal lavage decreases postoperative C-reactive protein concentrations: a RCT

et al. 2015

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Although extensive lavage is useful in peritoneal infections as diverticulitis, the extent of peritoneal lavage that should be used at the end of surgery is unclear. A randomised controlled trial comparing standard lavage with 0.5 litre (L) with extensive 8-L lavage was performed in 20 consecutive patients, following a full thickness resection of the rectum for deep endometriosis. Randomisation was done by the research nurse using sealed envelopes. Endpoints were C-reactive protein (CRP) concentration, white blood cell (WBC) count, temperature and the occurrence of complications. After lavage with 8 L, the CRP concentrations were consistently lower than that after lavage with 0.5 L and this from day 1 to day 7 after surgery (P=0.01). Rigorous peritoneal lavage seems preferable when a risk of pelvic contamination exists. Clinicaltrials.gov registration: NCT00930696

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Section: Discussionmentioning

confidence: 99%

Extensive peritoneal lavage decreases postoperative C-reactive protein concentrations: a RCT

et al. 2015

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“…In nonrandomized series, hampered by patient selection, laparoscopic treatment accompanied by intravenous antibiotics seems to be an effective and safe treatment in Hinchey III patients (level C [57,118]). However, the results of the first randomized trial need to be reviewed for a definite conclusion [119]. …”

Section: Treatment Of Complicated Diverticulitismentioning

confidence: 99%

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Andeweg¹,

Mulder²,

et al. 2013

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Background: The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline for diagnosis and treatment of diverticulitis is needed. Methods: A multidisciplinary working group, representing experts of relevant specialties, was involved in the guideline development. A systematic literature search was conducted to collect scientific evidence on epidemiology, classification, diagnostics and treatment of diverticulitis. Literature was assessed using the classification system according to an evidence-based guideline development method, and levels of evidence of the conclusions were assigned to each topic. Final recommendations were given, taking into account the level of evidence of the conclusions and other relevant considerations such as patient preferences, costs and availability of facilities. Results: The natural history of diverticulitis is usually mild and treatment is mostly conservative. Although younger patients have a higher risk of recurrent disease, a higher risk of complications compared to older patients was not found. In general, the clinical diagnosis of ACD is not accurate enough and therefore imaging is indicated. The triad of pain in the lower left abdomen on physical examination, the absence of vomiting and a C-reactive protein >50 mg/l has a high predictive value to diagnose ACD. If this triad is present and there are no signs of complicated disease, patients may be withheld from further imaging. If imaging is indicated, conditional computed tomography, only after a negative or inconclusive ultrasound, gives the best results. There is no indication for routine endoscopic examination after an episode of diverticulitis. There is no evidence for the routine administration of antibiotics in patients with clinically mild uncomplicated diverticulitis. Treatment of pericolic or pelvic abscesses can initially be treated with antibiotic therapy or combined with percutaneous drainage. If this treatment fails, surgical drainage is required. Patients with a perforated ACD resulting in peritonitis should undergo an emergency operation. There is an ongoing debate about the optimal surgical strategy. Conclusion: Scientific evidence is scarce for some aspects of ACD treatment (e.g. natural history of ACD, ACD in special patient groups, prevention of ACD, treatment of uncomplicated ACD and medical treatment of recurrent ACD), leading to treatment being guided by the surgeon's personal preference. Other aspects of the management of patients with ACD have been more thoroughly researched (e.g. imaging techniques, treatment of complicated ACD and elective surgery of ACD). This guideline of the diagnostics and treatment of ACD can be used as a reference for clinicians who treat patients with ACD.

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“…Indeed, several systemic reviews and meta-analyses [19,20,21,22,23] concluded that further investigation is needed in order to define the role of laparoscopic peritoneal lavage and drainage in the treatment of acute diverticulitis. The LADIES trial, a Dutch multicenter prospective trial [24] that compared peritoneal lavage, Hartmann procedure and resection with primary anastomosis has been prematurely terminated at interim analysis owing to high complication rates in the lavage and drainage group. A Scandinavian prospective multicenter trial is currently accruing, but results are pending.…”

Section: Discussionmentioning

confidence: 99%

Early Experience with Laparoscopic Lavage in Acute Complicated Diverticulitis

Horesh

Zbar²,

Haim³

et al. 2015

Dig Surg

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Background: Contemporary surgical management of complicated diverticulitis is controversial. Traditionally, the gold standard has been resection and colostomy, but recently peritoneal lavage and drainage without resection in cases of purulent peritonitis have been suggested. This study aims to review our initial experience with laparoscopic peritoneal lavage for complicated diverticulitis. Methods: Retrospective review of all patients who underwent emergent peritoneal lavage and drainage for acute complicated diverticulitis. Results: Five-hundred-thirty-eight patients admitted for acute diverticulitis between 2007 and 2012 were recorded in the database. Thirty seven underwent emergent surgery of which 10 had peritoneal lavage and drainage without colonic resection for complicated diverticulitis causing peritonitis. Peritoneal lavage and drainage resulted in the resolution of acute symptoms in all cases. In long-term follow-up, 3 (30%) patients required elective resection owing to symptomatic disease, two of these due to recurrent diverticulitis, and one owing to complicated fistula following the procedure. Conclusion: Peritoneal lavage is a feasible option for complicated diverticulitis with purulent non-fecal peritonitis, but a significant portion of the patients may require elective resection. Comparative studies with emergent resection are needed to determine the role of peritoneal lavage in complicated diverticulitis.

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The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitisA and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitisB in perforated diverticulitis (NTR2037)

Cited by 118 publications

References 27 publications

Extensive peritoneal lavage decreases postoperative C-reactive protein concentrations: a RCT

Extensive peritoneal lavage decreases postoperative C-reactive protein concentrations: a RCT

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Early Experience with Laparoscopic Lavage in Acute Complicated Diverticulitis

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