Acute diverticulitis with perforation and peritonitis is a serious complication affecting up to 12% of patients. Peritonitis is classified into purulent (Hinchey III) or fecal (Hinchey IV) categories. The standard treatment has traditionally involved emergency surgery, such as bowel resection with or without anastomosis or Hartmann's procedure, both of which carry high morbidity and mortality risks.
In 2008, laparoscopic peritoneal lavage (LPL) emerged as a less invasive alternative for treating purulent peritonitis. This article outlines the LPL technique, emphasizing patient selection, procedural steps, and postoperative care.
Several clinical trials have compared LPL to traditional resection methods. These trials show that while LPL is associated with lower stoma prevalence and shorter recovery times, it also carries a higher risk of reoperation and misdiagnosis, especially in cases of fecal peritonitis. Proper patient selection, such as excluding immunosuppressed patients and those with Hinchey IV peritonitis, and careful intraoperative assessment are crucial for successful outcomes. While LPL is not superior to resection, it is a viable alternative in select cases.
LPL offers a minimally invasive option for treating complicated diverticulitis in appropriately selected patients, though careful surgical expertise and patient-centered decision-making are essential to optimizing results.