Damage control strategy for the management of perforated diverticulitis with generalized peritonitis: laparoscopic lavage and drainage vs. laparoscopic Hartmann's procedure

被引:59
作者
Liang, Song [1 ]
Russek, Karla [1 ]
Franklin, Morris E., Jr. [1 ]
机构
[1] Texas Endosurg Inst, San Antonio, TX 78222 USA
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2012年 / 26卷 / 10期
关键词
Hinchey classification; Laparoscopic Hartmann's; Laparoscopic peritoneal lavage and drainage; Perforated diverticulitis; PRIMARY ANASTOMOSIS; COMPLICATED DIVERTICULITIS; SIGMOID DIVERTICULITIS; PLANNED RELAPAROTOMY; CONTROL LAPAROTOMY; EMERGENCY-SURGERY; COLONIC RESECTION; DISEASE; REVERSAL; DIAGNOSIS;
D O I
10.1007/s00464-012-2255-y
中图分类号
R61 [外科手术学];
学科分类号
摘要
This study was designed to compare laparoscopic peritoneal lavage and drainage (LLD) with laparoscopic Hartmann's procedure (LHP) in the management of perforated diverticulitis and to investigate a safer and more effective laparoscopic method for managing acute perforated diverticulitis with generalized peritonitis. A consecutive series of patients who underwent emergent LHP or LLD for perforated diverticulitis were identified from a prospectively designed database. All procedure-related information was collected and analyzed. P < 5 % was considered statistically significant in this study. A total of 88 patients underwent emergent laparoscopic procedures (47 LLD and 41 LHP) between 1995 and 2010 for acute perforated diverticulitis. Diagnostic laparoscopy classified 74 (84.1 %) patients as Hinchey III or IV perforated diverticulitis. OT for LHP was 182 +/- A 54.7 min, and EBL was 210 +/- A 170.5 ml. Six LHP (14.6 %) were converted to open Hartmann's for various reasons. Moreover the rates of LHP-associated postoperative mortality and morbidity were 2.4 and 17.1 %, respectively. For LLD, the operating time was 99.7 +/- A 39.8 min, and blood loss was 34.4 +/- A 21.2 ml. Three patients (6.4 %) were reoperated for the worsening of septic symptoms during post-LLD course. Moreover, the patients with LHP had significantly longer hospital stay than the ones with LLD did (16.3 +/- A 10.1 vs. 6.7 +/- A 2.2 days, P < 0.01). In the long-term follow-up, the rate of colostomy closure for LHP is 72.2 %, and 21 of 47 patients who underwent LLD had elective sigmoidectomy for the source control with the rate of 44.7 %. Both LHP and LLD can be performed safely and effectively for managing severe diverticulitis with generalized peritonitis. Compared with LHP, LLD does not remove the pathogenic source; however, the clinical application of this damage control operation to our patients showed significantly better short- and long-term clinical outcomes for managing perforated diverticulitis with various Hinchey classifications.
引用
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页码:2835 / 2842
页数:8
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