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Laparoscopic lavage and drainage for Hinchey III diverticulitis: review of technical aspects

  • Matteo Gregori
  • Diletta Cassini
  • Norma Depalma
  • Michelangelo Miccini
  • Farshad Manoochehri
  • Gianandrea A. Baldazzi
Review Article
  • 79 Downloads
Part of the following topical collections:
  1. Mini Invasive Colorectal Surgery

Abstract

The surgical treatment for patients with generalized peritonitis complicating sigmoid diverticulitis is currently debated; particularly in case of diffuse purulent contamination (Hinchey 3). Laparoscopic lavage and drainage (LLD) has been proposed by some authors as a safe and effective alternative to single- or multi-stage resective surgery. However, among all the different studies on LLD, there is no uniformity in terms of surgical technique adopted and data show significant differences in postoperative outcomes. Aim of this review was to analyze the differences and similarities among the authors in terms of application, surgical technique and outcomes of LLD in Hinchey 3 patients. A bibliographical research was performed by referring to PubMed and Cochrane. “Purulent peritonitis”, “Hinchey 3 diverticulitis”, “acute diverticulitis”, “colonic perforation” and “complicated diverticulitis” were used as key words. Twenty-eight papers were selected, excluding meta-analysis, reviews and case reports with a very small number of patients. The aim of this review was to establish how LLD should be done, suggesting important technical tricks. We found agreement in terms of indications, preoperative management, ports’ positioning, antibiotics, enteral feeding and drain management. On the contrast, different statements regarding indications, adhesiolysis and management of colonic hole and failure of laparoscopic lavage are reported. A widespread diffusion of LLD and standardization of its technique are impossible because of data heterogeneity and selection bias in the limited RCTs. It is necessary to wait for long terms results from randomized clinical trials (RCTs) in progress to establish the efficacy and safety of this technique. More importantly, an increased number of highly skilled and dedicated colorectal laparoscopic surgeons are required to standardized the procedure.

Keywords

Laparoscopic lavage Hinchey 3 diverticulitis Purulent peritonitis Complicated diverticulitis Acute diverticulitis 

Notes

Compliance with ethical standards

Conflict of interest

We have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Research involving human participants and/or animals

All procedure performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

An informed consent was obtained from the patient involved in the study.

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Copyright information

© Italian Society of Surgery (SIC) 2018

Authors and Affiliations

  • Matteo Gregori
    • 1
    • 4
  • Diletta Cassini
    • 2
  • Norma Depalma
    • 3
  • Michelangelo Miccini
    • 3
  • Farshad Manoochehri
    • 2
  • Gianandrea A. Baldazzi
    • 2
  1. 1.University Hospitals Birmingham“Queen Elizabeth Hospital” BirminghamBirminghamUK
  2. 2.Department of Mini-invasive and Robotic SurgeryAbano TermeItaly
  3. 3.First Department of Surgery “Pietro Valdoni”“Sapienza” Medical SchoolRomeItaly
  4. 4.BirminghamUK

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