Penna M, et al. - Researchers performed a comparison of clinical outcomes after laparoscopic lavage (LL) or colonic resection (CR) for purulent diverticulitis. observations revealed nearly 3 times higher risk of persistent peritonitis, intraabdominal abscesses and the need for emergency surgery in association with the preservation of diseased bowel by LL compared with CR.

Methods

• Researchers conducted electronic searches of Embase, Medline, Web of Science, and Cochrane databases.
• For effect size of continuous variables, they calculated weighted mean differences (WMD) and for discrete variables, pooled odds ratios (POR) were calculated.

Results

• From 3 randomized controlled trials (RCTs) and 4 comparative studies, they included a total of 589 patients; 85% as Hinchey III.
• LL group was comprised of younger patients with higher body mass index and lower ASA grades, however Hinchey classification and previous diverticulitis rates were comparable.
• Researchers recognized no significant differences for mortality, 30-day reoperations and unplanned readmissions.
• LL group indicated higher rates of intraabdominal abscesses (POR = 2.85; 95% confidence interval, CI, 1.52–5.34; P=0.001), peritonitis (POR = 7.80; 95% CI 2.12–28.69; P=0.002), and increased long-term emergency reoperations (POR = 3.32; 95% CI 1.73–6.38; P < 0.001).
• LL proved beneficial in terms of shorter operative time, fewer cardiac complications, fewer wound infections, and shorter hospital stay.
• After CR, more than 90% had stomas, of whom, 74% underwent stoma reversal within 12-months.
• In this study, nearly, 14% of LL patients required a stoma; 48% obtaining gut continuity within 12-months, whereas 36% underwent elective sigmoidectomy.