Two-stage laparoscopic management of complicated acute diverticulitis. Initial experience

Today no secure, consensus exists about the best treatment of complicated diverticulitis. The classic surgical procedures are associated to a high immediate and delayed morbidity. In the last few years several more conservative techniques have been suggested to allow a later elective resection. Laparoscopic exploration, peritonel lavage, and drain of the abdominal cavity followed by an elective sigmoid laparoscopic resection is a new minimal invasive approach. This approach has been applied in our unit to treat four patients. All patients had an acute abdomen due to complicated diverticulitis and one patient had evidence of free air at the abdomen x-ray. At emergent operation pus was cleaned, a peritoneal lavage was carried out, a drain was placed near the colonic lesion and another one in the pelvis. Patients fully recovered without complication and 2 to 28 weeks after first operation an elective laparoscopic resection of descending and sigmoid colon with a Knight-Griffen colorectal anastomosis was performed. Neither residual abscess nor dense adhesions were found at the second operations. There were no complications and median hospital stay after the second operation was 10 days (range, 8-13 days). Laparoscopic treatment of generalized peritonitis due to perforated diverticulitis is an attractive alternative to the traditional management of this disease. Our initial results are comparable to that published in the literature. This approach can he safe and effective in selected cases of complicated acute diverticulitis.