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Objective:
To compare the outcome of patients undergoing laparoscopic peritoneal lavage (LP) compared to Hartmann’s procedure (HP) for non feculent perforated diverticulitis with equivalent severity.
Design:
Retrospective review of patients from 2007-2012.
Setting:
University based surgery practice
Patients:
Patients admitted with perforated diverticulitis who underwent operative intervention.
Interventions:
Laparoscopic peritoneal lavage (LP) & Hartmann’s procedure (HP)
Outcomes:
Postoperative morbidity and mortality, LOS, recurrence and incidence of further surgery
Results:
79 patients underwent operative management for perforated diverticulitis. Patients with feculent peritonitis (Hinchey class IV, n=15) were excluded, resulting in 13 (20%) in LP and 51 (80%) in HP. Patients were similar in age, gender and ASA class. Disease severity (Hinchey class) and mortality were similar in both groups, whereas length of stay and complications were significantly lower in LP (see table). Two patients in LP had prolonged ileus requiring parenteral nutrition, one developed atrial fibrillation, and the fourth died from cardiomyopathy. Of the 37 patients with complications in HP, 16 developed incisional hernia (31%) and six patients (12%) developed stoma complications (necrosis, retraction, or stricture). Four patients in LP (31%) developed recurrent diverticulitis and all were subsequently managed with laparoscopic sigmoid resection and primary anastomosis.
Conclusions:
Patients undergoing LP compared to HP for perforated non feculent diverticulitis are, less likely to develop abdominal wall complications, have shorter LOS, and recurrence can be managed with subsequent resection and. LP is a valuable tool in the management of non-feculent perforated diverticulitis.

LP v HP: Disease Severity and Complications

	LP n=13	HP n=51	Total n=64	p value
Hinchey -I -II -III	n (%) 1 (8) 3 (32) 9 (69)	n (%) 6 (12) 21 (41) 24 (47)	n (%) 7 (11) 24 (38) 33 (52)	0.33
LOS Days	6.8	13.4	12	0.001
Complications (%)	4 (31)	37 (73)	41 (64)
Mortality (%)	1 (7.7)	2 (4)	3 (4.7)	0.5