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International Journal of Colorectal... Jan 2023Recently, treatment of Hinchey III diverticulitis by laparoscopic peritoneal lavage has been questioned. Moreover, long-term outcomes have been scarcely reported....
PURPOSE
Recently, treatment of Hinchey III diverticulitis by laparoscopic peritoneal lavage has been questioned. Moreover, long-term outcomes have been scarcely reported. Primary outcome was to determine the recurrence rate of diverticulitis after a successful laparoscopic peritoneal lavage in Hinchey III diverticulitis. Secondary outcomes were identification of associated risk factors for recurrence and elective sigmoidectomy rate.
METHODS
A retrospective cohort study in a tertiary referral center was performed. Patients with Hinchey III diverticulitis who underwent a successful laparoscopic peritoneal lavage between June 2006 and December 2019 were eligible. Diverticulitis recurrence was analyzed according to the Kaplan-Meier and log-rank test, censoring for death, loss of follow-up, or elective sigmoid resection in the absence of recurrence. Risk factors for recurrence were identified using Cox regression analysis.
RESULTS
Sixty-nine patients had a successful laparoscopic peritoneal lavage (mean age: 63 years; 53.6% women). Four patients had an elective sigmoid resection without recurrences. Recurrence rate was 42% (n = 29) after a median follow-up of 63 months. The cumulative global recurrence at 1, 3, and 5 years was 30% (95% CI, 20-43%), 37.5% (95% CI, 27-51%), and 48.9% (95% CI, 36-64%), respectively. Smoking (HR, 2.87; 95% CI, 1.22-6.5; p = 0.016) and episodes of diverticulitis prior to laparoscopic peritoneal lavage (HR, 5.2; 95% CI, 2.11-12.81; p < 0.001) were independently associated with an increased risk of recurrence.
CONCLUSIONS
Diverticulitis recurrence after a successful laparoscopic peritoneal lavage is high, decreasing after the first year of follow-up. Smoking and previous episodes of acute diverticulitis independently increase the risk of new episodes of diverticulitis.
Topics: Humans; Female; Middle Aged; Male; Diverticulitis, Colonic; Peritoneal Lavage; Retrospective Studies; Diverticulitis; Risk Factors; Laparoscopy; Peritonitis; Intestinal Perforation; Treatment Outcome
PubMed: 36658230
DOI: 10.1007/s00384-023-04314-y -
The Veterinary Record May 2017A prospective, randomised, non-blinded, clinical study to assess the effect of peritoneal lavage using warmed fluid on body temperature in anesthetised cats and dogs of... (Randomized Controlled Trial)
Randomized Controlled Trial
A prospective, randomised, non-blinded, clinical study to assess the effect of peritoneal lavage using warmed fluid on body temperature in anesthetised cats and dogs of less than 10 kg body mass undergoing coeliotomy. A standardised anaesthetic protocol was used. Oesophageal and rectal temperatures were measured at various time points. At the end of surgery, group 1 patients (n=10) were lavaged with 200 ml/kg sterile isotonic saline at 34±1°C and group 2 (n=10) at 40±1°C. Groups were similar with respect to age, mass, body condition and surgical incision length. Duration of anaesthesia, surgical procedures and peritoneal lavage was similar between groups. Linear regression showed no significant change in oesophageal temperature during the lavage period for group 1 (P=0.64), but a significant increase for group 2 patients (P<0.0001), with mean temperature changes of -0.5°C (from (36.3°C to 35.9°C) and +0.9°C (from 35.4°C to 36.3°C), respectively. Similar results were found for rectal temperature, with mean changes of -0.5°C and +0.8°C (P=0.922 and 0.045), respectively. The use of isotonic crystalloid solution for peritoneal lavage at a temperature of 40±1°C significantly warms small animal patients, when applied in a clinical setting, compared with lavage solution at 34±1°C.
Topics: Anesthesia; Animals; Body Temperature; Cats; Dogs; Peritoneal Lavage; Prospective Studies; Solutions; Temperature; Treatment Outcome
PubMed: 28283668
DOI: 10.1136/vr.103894 -
Techniques in Coloproctology Feb 2015The ideal treatment of perforated diverticulitis and the indications for elective colon resection remain controversial. Considering the significant morbidity and...
BACKGROUND
The ideal treatment of perforated diverticulitis and the indications for elective colon resection remain controversial. Considering the significant morbidity and mortality rates related to traditional resection, efforts have been made to reduce the invasiveness of surgery in recent decades. Laparoscopic peritoneal lavage has emerged as an effective alternative option. We retrospectively investigated the effectiveness of laparoscopic peritoneal lavage for perforated diverticulitis and the possibility that it could be a definitive treatment.
METHODS
We included patients treated with laparoscopic peritoneal lavage for perforated diverticulitis. The inclusion criteria were all emergency patients with generalized peritonitis due to Hinchey III perforated diverticulitis and some cases of Hinchey II and IV.
RESULTS
Sixty-three patients were treated with laparoscopic peritoneal lavage. Six patients (9.5 %) had Hinchey II diverticulitis; 54 patients (85.7 %) had Hinchey III; and three patients (4.8 %) had Hinchey IV. The mean operative time was 87.3 min (±25.4 min), and the overall morbidity rate was 14.3 %. One patient died because of pulmonary embolism, and there were six early reinterventions because of treatment failure. Delayed colon resection was performed in four of the remaining 57 patients (7 %) because of recurrent diverticulitis. In the other 53 patients (93 %), we saw no recurrence of diverticulitis and no intervention was performed after a median follow-up period of 54 months (interquartile range 27-98 months).
CONCLUSIONS
Laparoscopic peritoneal lavage for perforated diverticulitis can be considered a safe and effective alternative to traditional surgical resection, and using this approach, most elective colon resection might be avoided.
Topics: Adult; Aged; Diverticulitis, Colonic; Female; Humans; Intestinal Perforation; Laparoscopy; Length of Stay; Male; Middle Aged; Operative Time; Peritoneal Lavage; Peritonitis; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 25550116
DOI: 10.1007/s10151-014-1258-1 -
Diseases of the Colon and Rectum Dec 2014Over the past few years, the laparoscopic peritoneal lavage has emerged as a therapeutic alternative to standard resection procedures. However, its effectiveness and...
BACKGROUND
Over the past few years, the laparoscopic peritoneal lavage has emerged as a therapeutic alternative to standard resection procedures. However, its effectiveness and applicability remain debatable.
OBJECTIVE
The aim of this study was to assess laparoscopic lavage in controlling abdominal sepsis secondary to purulent peritonitis.
DESIGN
This study was conducted as a retrospective analysis of prospectively collected data.
SETTING
This study was conducted at a single tertiary care institution.
PATIENTS
Patients requiring emergency surgery for perforated diverticulitis and generalized peritonitis between June 2006 and June 2013 were identified from a prospective database. Laparoscopic assessment was considered in all of the hemodynamically stable patients, and laparoscopic lavage was performed according to intraoperative strict criteria.
MAIN OUTCOME MEASURES
Primary outcomes were the effectiveness and applicability of laparoscopic lavage. Secondarily, feasibility, morbidity, and mortality were also assessed.
RESULTS
Seventy-five patients required emergency surgery for generalized peritonitis secondary to perforated diverticulitis. Forty-six patients who underwent laparoscopy presented a purulent generalized (Hinchey III) peritonitis and were examined under the intention-to-treat basis to perform a laparoscopic lavage. Thirty-two patients (70.0%; 95% CI 56.2-82.7) had no previous episodes of diverticulitis. Thirty-six patients (78.0%; 95% CI 66.3-90.1) had free air on a CT scan. The conversion rate was 4% (95% CI 0-10). The feasibility of the method was 96.0% (95% CI 90.4-100), and its applicability was 59.0% (95% CI 44.8-73.2). Median operative time was 89 minutes (range, 40-200 minutes). Postoperative morbidity was 24.0% (95% CI 11.7-36.3), and the mortality rate was 0%. We registered 5 failures, and all of them underwent reoperation. The effectiveness of the procedure was 85% (95% CI 76-93).
LIMITATIONS
This was a single-institution retrospective study.
CONCLUSIONS
The effectiveness of laparoscopic lavage seems to be high. Although its applicability is lower, it could be applied in more than half of patients requiring emergency surgery. This alternative strategy should be considered when laparoscopic assessment reveals Hinchey III diverticulitis.
Topics: Aged; Argentina; Diverticulitis, Colonic; Feasibility Studies; Female; Humans; Intestinal Perforation; Laparoscopy; Male; Mortality; Operative Time; Peritoneal Lavage; Peritonitis; Postoperative Complications; Reoperation; Retrospective Studies; Severity of Illness Index; Suppuration; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25380004
DOI: 10.1097/DCR.0000000000000252 -
Asian Journal of Endoscopic Surgery Jan 2020The primary concern with laparoscopic intraoperative peritoneal lavage (IOPL) for generalized peritonitis relates to the difficulty and uncertainty in ensuring adequate...
INTRODUCTION
The primary concern with laparoscopic intraoperative peritoneal lavage (IOPL) for generalized peritonitis relates to the difficulty and uncertainty in ensuring adequate washout of contaminated fluid. Here, we describe a new method of laparoscopy-assisted IOPL.
METHODS
We performed emergency surgery in 10 patients with generalized peritonitis necessitating IOPL. A small wound retractor was inserted into the abdominal cavity through an incision and elevated to raise the abdominal wall. More than 3-L saline was injected via the retractor at one time. The abdomen was manually shaken by pressure from outside the body. Contaminated fluid was removed with a long suction device through the retractor. This procedure was repeated until the fluid was confirmed to be transparent by laparoscopy, and then drains were placed.
RESULTS
Median lavage time was 23.5 minutes (range, 15-34 minutes), and volume of lavage fluid was 19 L (range, 10-20 L). Median time to resumption of fluid intake was 3 days (range, 1-12 days), time to food intake was 6 days (range, 3-14 days), and time to first bowel movement was 5 days (range, 3-10 days). Median duration of antibiotic use was 8.5 days (range, 5-15 days). Complications were one case of antibiotic-induced rash, two cases of paralytic ileus, and one case of pelvic abscess. All patients recovered well without additional surgical intervention.
CONCLUSIONS
This new approach to laparoscopy-assisted IOPL was feasible for these patients with generalized peritonitis. This procedure enabled corpus lavage to be performed in a similarly short time to open surgery but with less invasiveness. Further research is needed to confirm indications and long-term outcomes.
Topics: Drainage; Female; Humans; Infusions, Parenteral; Intraoperative Care; Laparoscopy; Male; Middle Aged; Peritoneal Lavage; Peritonitis; Saline Solution
PubMed: 30672137
DOI: 10.1111/ases.12685 -
Colorectal Disease : the Official... Oct 2016
Topics: Diverticulitis, Colonic; Female; Humans; Intestinal Perforation; Laparoscopy; Male; Peritoneal Lavage
PubMed: 27248855
DOI: 10.1111/codi.13404 -
The American Journal of Emergency... Jul 1989A randomized prospective study compared open peritoneal lavage using a peritoneal dialysis catheter with modified closed lavage using either the Lazarus-Nelson or Cook... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
A randomized prospective study compared open peritoneal lavage using a peritoneal dialysis catheter with modified closed lavage using either the Lazarus-Nelson or Cook lavage catheter. The time required to perform the lavage, technical difficulties, complications, and accuracy were assessed in 63 adult victims of blunt abdominal trauma. The average time to perform lavage was 21.1 minutes for open lavage, 14.7 minutes for Lazarus-Nelson closed lavage, and 9.8 minutes for Cook closed lavage. The closed technique using the Cook catheter was significantly faster than open lavage. Technical difficulties were significantly less frequent with Cook catheter closed lavage than with Lazarus-Nelson catheter closed lavage. The overall complication rate was 1.8%, and the overall accuracy was 98.1%, without apparent difference among techniques. It is concluded that, when no contraindications to closed lavage exist, and when time is of importance, closed lavage with the Cook catheter is the preferred technique.
Topics: Abdominal Injuries; Adult; Female; Humans; Male; Peritoneal Lavage; Prospective Studies; Random Allocation; Wounds, Nonpenetrating
PubMed: 2735980
DOI: 10.1016/0735-6757(89)90037-5 -
Annals of the Royal College of Surgeons... Jul 2005Intra-operative peritoneal lavage (IOPL) is widely practised but its benefits are unclear. The frequency and pattern of its use amongst general surgeons is investigated.
INTRODUCTION
Intra-operative peritoneal lavage (IOPL) is widely practised but its benefits are unclear. The frequency and pattern of its use amongst general surgeons is investigated.
METHODS
A postal questionnaire was sent to 153 general surgical consultants and registrars enquiring about their use of IOPL. The surgeon was asked the volume and type of lavage fluid used, under various circumstances.
RESULTS
118 (77%) questionnaires were returned. 115 (97%) surgeons used IOPL. The majority of surgeons (61%) lavaged until the fluid was clear, 20% used more than 1 l and 17% used between 500-1000 ml. In the case of the dirty abdomen (i.e. gross pus or faecal peritonitis), 47% used saline as the lavage fluid, 38% aqueous betadine, 9% water and 3% antibiotic lavage. Similar results were found in the case of a contaminated abdomen (i.e. a breached hollow viscus). 34% of surgeons used IOPL during clean cases. 36% used water lavage during intra-abdominal cancer surgery; 21% lavaged with saline and 17% with betadine. More registrars (47%) than consultants (29%) lavaged with water during cancer surgery. Consultants, however, used more aqueous betadine.
CONCLUSIONS
The frequency of use and choice of lavage fluid varies widely. The successful management of the septic abdomen rests on at least 3 tenants - systemic antibiotics, control of the source of infection and aspiration of gross contaminants. There is little good evidence in the literature to support IOPL in the management of the septic abdomen. The use of IOPL during cancer surgery is supported by in vitro evidence. The current use of IOPL, as shown by this study, appears not to be evidence based.
Topics: Anti-Infective Agents, Local; General Surgery; Health Care Surveys; Humans; Intraoperative Care; Peritoneal Lavage; Povidone-Iodine; Professional Practice; Sodium Chloride; Water
PubMed: 16053685
DOI: 10.1308/1478708051847 -
The British Journal of Surgery Nov 2014Laparoscopic peritoneal lavage has been proposed for generalized peritonitis from perforated diverticulitis to avoid a stoma. Reports of its feasibility and safety are...
BACKGROUND
Laparoscopic peritoneal lavage has been proposed for generalized peritonitis from perforated diverticulitis to avoid a stoma. Reports of its feasibility and safety are promising. This study aimed to establish determinants of failure to enable improved selection of patients for this approach.
METHODS
The study included all patients with perforated sigmoid diverticulitis who underwent emergency laparoscopic peritoneal lavage from January 2000 to December 2013. Factors predicting failure of laparoscopic treatment were analysed from data collected retrospectively.
RESULTS
For patients undergoing emergency sigmoid resection (72 of 361), mortality and morbidity rates were 13 and 35 per cent respectively. In all, 71 patients had laparoscopic lavage, with mortality and morbidity rates of 6 and 28 per cent respectively. Reintervention was necessary in 11 patients (15 per cent) for unresolved sepsis. Age 80 years or more, American Society of Anesthesiologists grade III or above, and immunosuppression were associated with reintervention.
CONCLUSION
Elderly patients and those with immunosuppression or severe systemic co-morbidity are at risk of reintervention after laparoscopic lavage.
Topics: Adult; Aged; Aged, 80 and over; Diverticulitis, Colonic; Female; Humans; Intestinal Perforation; Laparoscopy; Male; Middle Aged; Peritoneal Lavage; Peritonitis; Postoperative Complications; Prospective Studies; Reoperation; Risk Factors; Sigmoid Diseases; Treatment Failure; Treatment Outcome
PubMed: 25203523
DOI: 10.1002/bjs.9621 -
PancreasThe aims of this review were to determine whether positive peritoneal lavage cytology (CY+) precludes radical resection in pancreatic cancer and to propose prospections... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aims of this review were to determine whether positive peritoneal lavage cytology (CY+) precludes radical resection in pancreatic cancer and to propose prospections for future studies.
METHODS
MEDLINE, Embase, and Cochrane Central were searched for related articles. Dichotomous variables and survival outcomes were analyzed with the estimation of odds ratio and hazards ratio (HR), respectively.
RESULTS
A total of 4905 patients were included, of which 7.8% were CY+. Positive peritoneal lavage cytology was correlated with poor overall survival (univariate survival analysis [HR, 2.35; P < 0.00001]; multivariate analysis [HR, 1.62; P < 0.00001]), poor recurrence-free survival (univariate survival analysis [HR, 2.50; P < 0.00001]; multivariate analysis [HR, 1.84; P < 0.00001]), and higher initial peritoneal recurrence rate (odds ratio, 5.49; P < 0.00001).
CONCLUSIONS
Although CY+ predicts poor prognosis and a higher risk of peritoneal metastasis after curative resection, it is not sufficient to preclude curative resection based on the current evidence, and high-quality trials should be conducted to assess the prognostic impact of operation among resectable CY+ patients. In addition, more sensitive and accurate methods to detect peritoneal exfoliated tumor cells and more effective comprehensive treatment for resectable CY+ pancreatic cancer patients are clearly warranted.
Topics: Humans; Cytology; Peritoneum; Pancreatic Neoplasms; Peritoneal Lavage; Peritoneal Neoplasms; Prognosis; Retrospective Studies
PubMed: 37099766
DOI: 10.1097/MPA.0000000000002163