What is the current role of laparoscopic lavage in perforated diverticulitis?

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Excerpt

Diverticulosis is a very common condition, affecting 30% to 50% of adults over the age of 50 and over 65% of those over the age of 80. About one quarter of patients with diverticulosis will at some point suffer diverticultis, of whom one quarter will have “complicated diverticular disease,” defined as diverticulitis associated with phlegmon, abscess, fistula, stricture presenting with obstruction, or perforation with peritonitis.1 In 2012, the current authors collaborated on a Western Trauma Association (WTA) “Critical Decisions” algorithm entitled, “Management of complicated diverticulitis.”1 In the WTA algorithm, we recommended laparoscopic lavage and drainage (LLD) for the management of purulent peritonitis for those patients not presenting in septic shock. This recommendation was based on favorable outcomes reported in several case series.2,3 Since the publication of the 2012 WTA guideline,1 the results from at least three prospective randomized clinical trials (PRCTs) have been published, which call into question the utility of the LLD procedure.4–6 The results of these studies warrant reevaluation of the role of LLD in the management of perforated diverticulitis with purulent peritonitis.

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