Laparoscopic treatment of complicated colonic diverticular disease: A review

Abstract

Up to 10% of acute colonic diverticulitis may necessitate a surgical intervention. Although associated with high morbidity and mortality rates, Hartmann’s procedure (HP) has been considered for many years to be the gold standard for the treatment of generalized peritonitis. To reduce the burden of surgery in these situations and as driven by the accumulated experience in colorectal and minimally-invasive surgery, laparoscopy has been increasingly adopted in the management of abdominal emergencies. Multiple case series and retrospective comparative studies confirmed that with experienced hands, the laparoscopic approach provided better outcomes than the open surgery. This technique applies to all interventions related to complicated diverticular disease, such as HP, sigmoid resection with primary anastomosis (RPA) and reversal of HP. The laparoscopic approach also provided new therapeutic possibilities with the emergence of the laparoscopic lavage drainage (LLD), particularly interesting in the context of purulent peritonitis of diverticular origin. At this stage, however, most of our knowledge in these fields relies on studies of low-level evidence. More than ever, well-built large randomized controlled trials are necessary to answer present interrogations such as the exact place of LLD or the most appropriate sigmoid resection procedure (laparoscopic HP or RPA), as well as to confirm the advantages of laparoscopy in chronic complications of diverticulitis or HP reversal.

Keywords: Diverticulitis, Laparoscopy, Emergent, Lavage, Drainage, Peritonitis, Purulent, Stercoral, Complicated, Perforation

Core tip: With the aim to improve surgery outcomes, laparoscopy has been increasingly performed in complicated diverticulitis. Despite the absence of solid proofs and under the condition of large expertise, it is an appropriate approach for the surgical management of both elective and emergent situations related to complicated diverticulitis. Moreover, the laparoscopic lavage drainage represents a previously unknown modality of treatment of purulent peritonitis. Validation of these data by large-scale randomized controlled trials is mandatory to build future therapeutic algorithms on which general surgeons can rely in their daily practice.