Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2016; 8(5): 371-375
Published online May 27, 2016. doi: 10.4240/wjgs.v8.i5.371
Critical appraisal of laparoscopic lavage for Hinchey III diverticulitis
Pascal Gervaz, Patrick Ambrosetti
Pascal Gervaz, Division of Coloproctology, Clinique Hirslanden La Colline, 1205 Geneva, Switzerland
Patrick Ambrosetti, Clinique Générale-Beaulieu, 1206 Geneva, Switzerland
Author contributions: Gervaz P and Ambrosetti P contributed equally to this work in researching the literature and analyzing data; Gervaz P wrote the paper.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Pascal Gervaz, MD, Division of Coloproctology, Clinique Hirslanden La Colline, Avenue de la Roseraie 76A, 1205 Geneva, Switzerland.
Telephone: +41-22-7895050 Fax: +41-22-7890591
Received: November 11, 2015
Peer-review started: November 13, 2015
First decision: November 27, 2015
Revised: February 1, 2016
Accepted: February 23, 2016
Article in press: February 24, 2016
Published online: May 27, 2016

Laparoscopic lavage and drainage is a novel approach for managing patients with Hinchey III diverticulitis. However, this less invasive technique has important limitations, which are highlighted in this systematic review. We performed a PubMed search and identified 6 individual series reporting the results of this procedure. An analysis was performed regarding treatment-related morbidity, success rates, and subsequent elective sigmoid resection. Data was available for 287 patients only, of which 213 (74%) were actually presenting with Hinchey III diverticulitis. Reported success rate in this group was 94%, with 3% mortality. Causes of failure were: (1) ongoing sepsis; (2) fecal fistula formation; and (3) perforated sigmoid cancer. Although few patients developed recurrent diverticulitis in follow-up, 106 patients (37%) eventually underwent elective sigmoid resection. Our data indicate that laparoscopic lavage and drainage may benefit a highly selected group of Hinchey III patients. It is unclear whether laparoscopic lavage and drainage should be considered a curative procedure or just a damage control operation. Failure to identify patients with either: (1) feculent peritonitis (Hinchey IV); (2) persistent perforation; or (3) perforated sigmoid cancer, are causes of concern, and will limit the application of this technique.

Keywords: Diverticulitis, Colon, Emergency surgery, Outcome, Laparoscopy

Core tip: Laparoscopic lavage and drainage for purulent peritonitis due to perforated diverticulitis has many limitations, which have been overlooked in the previously published case series of the literature. The available data from the unique RCT indicates that these results will not be reproduced in a trial where patients’ selection is avoided. There are three main limitations to the technique: (1) the risk of missing a persistent (incompletely sealed) perforation - 30% of cases; (2) the risk of missing fecal peritonitis enclosed within the sigmoid loop - 10% of cases; and (3) the risk of missing sigmoid carcinoma - 10% of cases).