• Tristan Greilsamer, Emeric Abet, Guillaume Meurette, Michel Comy, Antoine Hamy, Paul-Antoine Lehur, Aurélien Venara, and Emilie Duchalais.
• 1 Department of Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France 2 Department of Digestive Surgery, Vendée Medical Center, La-Roche-Sur-Yon, France 3 Department of Visceral Surgery, University Hospital of Angers, Angers, France.
• Dis. Colon Rectum. 2017 Sep 1; 60 (9): 965-970.

BackgroundLaparoscopic peritoneal lavage is an alternative to sigmoid resection in Hinchey III diverticulitis (generalized purulent peritonitis). The main limitation of laparoscopic peritoneal lavage is the higher rate of reoperation for persistent sepsis in comparison with sigmoid resection.ObjectiveThe purpose of the current study was to identify risk factors for laparoscopic peritoneal lavage failure in patients who have Hinchey III diverticulitis.DesignThis was a retrospective multicenter study.SettingsThe study was conducted in 3 clinical sites in France.PatientsFrom 2006 to 2015, all consecutive patients undergoing emergent surgery for diverticulitis were reviewed. All patients operated on with laparoscopic peritoneal lavage for laparoscopically confirmed Hinchey III diverticulitis were included.Main Outcome MeasuresThe main outcome was laparoscopic peritoneal lavage failure, defined as reoperation or death at 30 postoperative days.ResultsA series of 71 patients (43 men, mean age 58 ± 15 years) were operated on with laparoscopic peritoneal lavage for Hinchey III diverticulitis. Laparoscopic peritoneal lavage failed in 14 (20%) of them: 1 died and 13 underwent reoperations. No major complication (Dindo-Clavien score ≥3) occurred after reoperation. Immunosuppressive drugs (p = 0.01) and ASA grade ≥3 (p = 0.02) were associated with laparoscopic peritoneal lavage failure after univariate analysis. Multivariate analysis identified only immunosuppressive drug intake (steroids or chemotherapy for cancer) as an independent predictive factor. Mean length of stay was 14.9 days (5-67). At the end of the 30 first postoperative days, 12 (17%) patients had a stoma.LimitationsThe study was limited by its retrospective nature and the small size of the cohort.ConclusionOur results highlight immunosuppressive drug intake as a major risk factor for laparoscopic peritoneal lavage failure in patients who have Hinchey III diverticulitis. Immunosuppression and severe comorbidities (ASA ≥3) should be considered when selecting a surgical option in patients with Hinchey III diverticulitis. See Video Abstract at http://links.lww.com/DCR/A423.

43 keywords...

hide…