Prevention of incisional hernia post emergency laparotomy: A time to change? A case series.

Abstract

Introduction: Complicated acute diverticulitis (CAD) is a surgical challenge in which a mini-invasive approach may be offered. Laparoscopic peritoneal lavage (LPL) was introduced as an alternative to sigmoid resection. However, the role of LPL is still under debate. Aim of this study was to evaluate which surgical strategy between LPL and Laparoscopic Sigmoidectomy (LS) could give better outcomes in CAD. Materials and methods: This prospective, observational, multicenter study lasted from 2015 until to 2018. Inclusion criteria: left colonic or sigmoid CAD (modified Hinchey’’s classification: grade II not responder to conservative treatment and grade III). Exclusion criteria: septic shock, immunodepression, previous multiple surgical operations, modified Hinchey’’s grade I and IV,\15 and[85 years. Comparisons were made between LPL and LS groups. Results: 66 patients were enrolled: 28 (42%) had LPL and 38 (58%) LS. Following sigmoidectomy, 24 pts (63%) had a primary anastomosis and 14 pts (37%) an end-colostomy (Hartmann’’s procedure). There were no significant differences regarding age, male gender rate and mean BMI (p = 0.314, p = 0.07, p = 0.129, respectively). ASA score [2 was significantly higher in LPL (p = 0.05). The number of previous episodes of diverticulitis and the mean C-Reactive Protein dosage were similar (p = 0.756 and 0.846). Mannheim Peritonitis Index was significantly higher in LPL (0.004). No differences were found regarding to the distribution of Hinchey’’s grades II and III (p = 0.727). 1 (4%) patient in LPL and 5 pts (13%) in LS needed a conversion to open surgery (p = 0.181). Overall, the morbidity rates were 33% in LPL and 18% in LS (p = 0.169). Organ space infection (30% vs 3%, p = 0.002) and the re-operation rates (18.5% vs 0; p = 0.006) resulted significantly higher in the LPL group. Mortality was nihil. Mean post-op length of stay was 11.4 days in LPL and 8.23 days in LS (p = 0.088). Diverticular recurrence was significantly increased in LPL (p = 0.003). Conclusions: Compared to LS, LPL is associated with increased ongoing sepsis, emergency re-intervention and recurrence of acute diverticulitis. The role of LPL for patients with CAD remains questionabl