Source: Surgical Endoscopy and Other Interventional Techniques; 2017; vol. 31
Publication Date: 2017
Abstract:Introduction: Controversy exists regarding the role of laparoscopic peritoneal lavage in patients with perforated diverticulitis. Our objective was to conduct the first meta-analysis of randomized controlled trials (RCT's) to compare the outcomes of patient undergoing laparoscopic peritoneal lavage with sigmoidectomy in patients with perforated diverticulitis. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; CENTRAL; The World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall morbidity, mortality, and postoperative complications were defined as the primary outcome parameters. Procedure time and length of hospital stay were secondary outcomes. The combined overall effect sizes were calculated using fixed-effect or random-effects models. Results: We identified 4 RCT's comparing outcomes of laparoscopic peritoneal lavage and open sigmoidectomy for perforated diverticulitis. All studies included only Hinchey grade III diverticulitis. The subsequent analysis, including 390 patients, demonstrated that that laparoscopic peritoneal lavage of perforated diverticulitis was associated with significantly increased rates of overall morbidity (OR: 1.30, 95% CI 1.07-1.57, p=0.007) and intra-abdominal abscess (OR: 3.10, 95% CI 1.71-5.63, p=0.0002) compared to sigmoidectomy. However, there was no significant difference in mortality (OR: 0.86, 95% CI 0.42-1.77, p=0.69) and re-operation (OR: 1.20, 95% CI 0.36-4.02, p=0.77) rates between the two groups. Between-study heterogeneity was non-significant in all analyses, except reoperation rate (I2=79%, p=0.002). The available data did not allow an appropriate analysis of length of hospital stay and other postoperative complications. Conclusions: Our analysis of randomised trials demonstrated that laparoscopic peritoneal lavage of perforated diverticulitis may lead to more adverse events than open sigmoid resection. Future high quality RCT's are indeed required to provide stronger evidence as no definitive conclusion can be drawn considering the limited number of available RCT'S.