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Diseases of the Colon and Rectum Sep 2017Laparoscopic peritoneal lavage is an alternative to sigmoid resection in Hinchey III diverticulitis (generalized purulent peritonitis). The main limitation of...
BACKGROUND
Laparoscopic peritoneal lavage is an alternative to sigmoid resection in Hinchey III diverticulitis (generalized purulent peritonitis). The main limitation of laparoscopic peritoneal lavage is the higher rate of reoperation for persistent sepsis in comparison with sigmoid resection.
OBJECTIVE
The purpose of the current study was to identify risk factors for laparoscopic peritoneal lavage failure in patients who have Hinchey III diverticulitis.
DESIGN
This was a retrospective multicenter study.
SETTINGS
The study was conducted in 3 clinical sites in France.
PATIENTS
From 2006 to 2015, all consecutive patients undergoing emergent surgery for diverticulitis were reviewed. All patients operated on with laparoscopic peritoneal lavage for laparoscopically confirmed Hinchey III diverticulitis were included.
MAIN OUTCOME MEASURES
The main outcome was laparoscopic peritoneal lavage failure, defined as reoperation or death at 30 postoperative days.
RESULTS
A series of 71 patients (43 men, mean age 58 ± 15 years) were operated on with laparoscopic peritoneal lavage for Hinchey III diverticulitis. Laparoscopic peritoneal lavage failed in 14 (20%) of them: 1 died and 13 underwent reoperations. No major complication (Dindo-Clavien score ≥3) occurred after reoperation. Immunosuppressive drugs (p = 0.01) and ASA grade ≥3 (p = 0.02) were associated with laparoscopic peritoneal lavage failure after univariate analysis. Multivariate analysis identified only immunosuppressive drug intake (steroids or chemotherapy for cancer) as an independent predictive factor. Mean length of stay was 14.9 days (5-67). At the end of the 30 first postoperative days, 12 (17%) patients had a stoma.
LIMITATIONS
The study was limited by its retrospective nature and the small size of the cohort.
CONCLUSION
Our results highlight immunosuppressive drug intake as a major risk factor for laparoscopic peritoneal lavage failure in patients who have Hinchey III diverticulitis. Immunosuppression and severe comorbidities (ASA ≥3) should be considered when selecting a surgical option in patients with Hinchey III diverticulitis. See Video Abstract at http://links.lww.com/DCR/A423.
Topics: Adult; Aged; Colon, Sigmoid; Comorbidity; Diverticulitis, Colonic; Emergency Treatment; Female; France; Humans; Immunosuppressive Agents; Laparoscopy; Male; Middle Aged; Peritoneal Lavage; Peritonitis; Postoperative Complications; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Treatment Failure
PubMed: 28796735
DOI: 10.1097/DCR.0000000000000891 -
International Journal of Colorectal... Dec 2019Laparoscopic peritoneal lavage (LPL) is feasible in selected patients with pelvic abscess and generalized purulent peritonitis caused by acute diverticulitis. We aimed... (Comparative Study)
Comparative Study Observational Study
PURPOSE
Laparoscopic peritoneal lavage (LPL) is feasible in selected patients with pelvic abscess and generalized purulent peritonitis caused by acute diverticulitis. We aimed to compare LPL and laparoscopic sigmoidectomy (LS) in complicated acute diverticulitis.
METHODS
This prospective, observational, multicenter study included patients with a pelvic abscess not amenable to conservative management and patients with Hinchey III acute diverticulitis, from 2015 to 2018. Sixty-six patients were enrolled: 28 (42%) underwent LPL and 38 (58%) underwent LS. In LS, patients had a primary anastomosis, with or without ileostomy, or an end colostomy (HA). Major outcomes were mortality, morbidity, failure of source control, reoperation, length of stay, and diverticulitis recurrence.
RESULTS
Patient demographics were similar in the two groups. In LPL, ASA score > 2 and Mannheim Peritonitis Index were significantly higher (p = 0.05 and 0.004). In LS, 24 patients (63%) had a PA and 14 (37%) an HA. No death was recorded. Overall, morbidity was 33% in LPL and 18% in LS (p = 0.169). However, failure to achieve source control of the peritoneal infection and the need to return to the operating room were more frequent in LPL (p = 0.002 and p = 0.006). Mean postoperative length of stay was comparable (p = 0.08). Diverticular recurrence was significantly higher in LPL (p = 0.003).
CONCLUSION
LPL is related to a higher reoperation rate, more frequent postoperative ongoing sepsis, and higher recurrence rates. Therefore, laparoscopic lavage for perforated diverticulitis carries a high risk of failure in daily practice.
Topics: Abdominal Abscess; Aged; Colectomy; Diverticulitis, Colonic; Europe; Female; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Peritoneal Lavage; Peritonitis; Postoperative Complications; Prospective Studies; Recurrence; Reoperation; Risk Assessment; Risk Factors; Sigmoid Diseases; Time Factors; Treatment Outcome
PubMed: 31713714
DOI: 10.1007/s00384-019-03429-5 -
Zentralblatt Fur Chirurgie 1999The peritoneal lavage in peritonitis can be studied in a standardized manner only in animal models, because peritonitis is too variable and dependent on too many patient... (Review)
Review
The peritoneal lavage in peritonitis can be studied in a standardized manner only in animal models, because peritonitis is too variable and dependent on too many patient related factors. In this article answers are given to questions on the influence of different lavage substances on survival, local and systemic concentrations of bacteria, endotoxin, and TNF as well as on mesothelial adherence of bacteria. These data refer to results from acute models of infection published in the literature. Furthermore, we show from our own chronic peritonitis model the influence of the peritoneal lavage on abscess formation and translocation. After inoculation of a Bacteroides fragilis suspension, a chronic abscess forming peritonitis was induced. At day 3/7/14 intraabdominal abscesses were found in 2/4/6 of 8/5/6 animals in an untreated, in 1/3/5 of 5/5/5 animals in a saline lavaged, and in 5/0/2 of 5/5/5 animals in a Taurolidin lavaged group, respectively. Both, the intraabdominal and the systemic bacterial dissemination were more effectively inhibited by the Taurolidin lavage than by the saline lavage.
Topics: Animals; Disease Models, Animal; Humans; Peritoneal Lavage; Peritonitis
PubMed: 10327574
DOI: No ID Found -
Journal of Visceral Surgery Jun 2016
Topics: Diverticulitis, Colonic; Humans; Intestinal Perforation; Laparoscopy; Peritoneal Lavage; Peritonitis; Treatment Outcome
PubMed: 27288823
DOI: 10.1016/j.jviscsurg.2016.04.004 -
Japanese Journal of Clinical Oncology Feb 2017Peritoneal recurrence after gastrectomy for gastric cancer is common and the prognosis is dismal. Recent evidence suggests that extensive peritoneal lavage with large... (Randomized Controlled Trial)
Randomized Controlled Trial
Peritoneal recurrence after gastrectomy for gastric cancer is common and the prognosis is dismal. Recent evidence suggests that extensive peritoneal lavage with large volume of normal saline after surgery before abdominal closure can reduce the risk of peritoneal recurrence and improve overall survival. This study aims to evaluate the benefit of extensive intraoperative peritoneal lavage. This is a prospective, open-label, multicentre randomised controlled trial involving 15 international centres in China, Korea, Japan, Malaysia and Singapore. Patients with cT3/4 stomach cancer undergoing curative resection are randomised to either extensive peritoneal lavage (10 l of saline) or standard lavage (≤2 l of saline). The primary outcome is overall survival and secondary outcomes include disease-free survival and peritoneal recurrence. The minimum sample size is 600 subjects with 300 per arm completing 3 years follow-up. The data will be analysed on an intention-to-treat basis, assuming a two-sided test with a 5% level of significance.
Topics: Adult; Aged; Aged, 80 and over; Disease-Free Survival; Female; Gastrectomy; Humans; Male; Middle Aged; Peritoneal Lavage; Prognosis; Prospective Studies; Stomach Neoplasms; Young Adult
PubMed: 28173154
DOI: 10.1093/jjco/hyw153 -
Acta Chirurgica Scandinavica Oct 1987
Review
Topics: Abdomen, Acute; Humans; Peritoneal Lavage; Peritonitis
PubMed: 3324593
DOI: No ID Found -
Diseases of the Colon and Rectum Dec 2004Tumor cells exfoliated into the peritoneal cavity during colorectal cancer surgery are viable and tumorigenic and may contribute to peritoneal recurrence. Although... (Comparative Study)
Comparative Study
PURPOSE
Tumor cells exfoliated into the peritoneal cavity during colorectal cancer surgery are viable and tumorigenic and may contribute to peritoneal recurrence. Although commonly used, the tumoricidal effectiveness of antiseptics in peritoneal lavage is doubted because of their chemical alteration by peritoneal secretions. In contrast, osmotic lysis by incubation in distilled water may offer an effective tumoricidal activity. Data defining the susceptibility of colorectal carcinoma cells to osmotic lysis are lacking and hence there is no consensus on optimal lavage methodology.
METHODS
We examined the cytocidal activity of water on colorectal cancer cell lines in culture and determined the effect of peritoneal secretions in vivo on the tumoricidal effectiveness of water.
RESULTS
Incubation of cells in distilled water resulted in cell lysis, with 100 percent lysis achieved after 14 minutes of incubation. In vivo, contamination of lavage water by peritoneal secretions produced a resultant solution with an osmolality of 50 mM. Sequential lavages reduced this contamination, enabling a final resultant solution with an osmolality of 10 mM, which produced 100 percent cell lysis after 32 minutes of incubation.
CONCLUSIONS
Current peritoneal lavage methodology is inadequate because complete cell lysis requires water incubation for longer time periods than is currently practiced. Solutions to this problem are discussed.
Topics: Anti-Infective Agents, Local; Body Fluids; Cell Count; Cell Culture Techniques; Cell Line, Tumor; Cell Survival; Colorectal Neoplasms; Drug Evaluation, Preclinical; Humans; Intraoperative Care; Linear Models; Neoplasm Seeding; Osmolar Concentration; Osmotic Pressure; Peritoneal Lavage; Peritoneum; Povidone-Iodine; Sodium Chloride; Time Factors; Tumor Cells, Cultured; Water
PubMed: 15657663
DOI: 10.1007/s10350-004-0788-4 -
Annales de Chirurgie Nov 2003Spontaneous or iatrogenous peritoneal seeding is responsible for locoregional recurrent cancer or peritoneal carcinomatosis. Few surgeons are used to wash the abdominal... (Review)
Review
Spontaneous or iatrogenous peritoneal seeding is responsible for locoregional recurrent cancer or peritoneal carcinomatosis. Few surgeons are used to wash the abdominal cavity to prevent peritoneal seeding. But experimentally, washing is not able to dislodge or destroy tumour cells adherent to the peritoneum or to the surgical wounds. The antitumoral effect of abdominal washing is increased by addition of antiseptics or anti-adherent agents.
Topics: Anti-Infective Agents, Local; Antineoplastic Agents; Biomechanical Phenomena; Carcinoma; Cell Adhesion; Drug Therapy, Combination; Humans; Intraoperative Care; Neoplasm Seeding; Peritoneal Lavage; Peritoneal Neoplasms; Treatment Outcome
PubMed: 14659611
DOI: 10.1016/j.anchir.2003.09.004 -
JAMA Surgery Jul 2019
Topics: Humans; Peritoneal Lavage; Peritoneal Neoplasms; Stomach Neoplasms
PubMed: 30916740
DOI: 10.1001/jamasurg.2019.0154 -
Der Chirurg; Zeitschrift Fur Alle... Jul 2017
Review
Topics: Diverticulitis, Colonic; Drainage; Humans; Intestinal Perforation; Laparoscopy; Peritoneal Lavage; Randomized Controlled Trials as Topic; Sigmoid Diseases
PubMed: 28600592
DOI: 10.1007/s00104-017-0455-7