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Two-year results of the randomized clinical trial DILALA comparing laparoscopic lavage with resection as treatment for perforated diverticulitis

Journal article
Authors A. Kohl
J. Rosenberg
David Bock
T. Bisgaard
S. Skullman
Anders Thornell
Jacob Gehrman
Eva Angenete
Eva Haglind
Published in British Journal of Surgery
Volume 105
Issue 9
Pages 1128-1134
ISSN 0007-1323
Publication year 2018
Published at Institute of Clinical Sciences, Department of Surgery
Pages 1128-1134
Language en
Links dx.doi.org/10.1002/bjs.10839
Keywords generalized peritonitis, purulent peritonitis, hartmanns procedure, surgical resection, metaanalysis, population, management, reversal, risk, Surgery
Subject categories Gastroenterology and Hepatology

Abstract

BackgroundTraditionally, perforated diverticulitis with purulent peritonitis was treated with resection and colostomy (Hartmann's procedure), with inherent complications and risk of a permanent stoma. The DILALA (DIverticulitis - LAparoscopic LAvage versus resection (Hartmann's procedure) for acute diverticulitis with peritonitis) and other randomized trials found laparoscopic lavage to be a feasible and safe alternative. The medium-term follow-up results of DILALA are reported here. MethodsPatients were randomized during surgery after being diagnosed with Hinchey grade III perforated diverticulitis at diagnostic laparoscopy. The primary outcome was the proportion of patients with one or more secondary operations from 0 to 24 months after the index procedure in the laparoscopic lavage versus Hartmann's procedure groups. The trial was registered as ISRCTN82208287. ResultsForty-three patients were randomized to laparoscopic lavage and 40 to Hartmann's procedure. Patients in the lavage group had a 45 per cent reduced risk of undergoing one or more operations within 24 months (relative risk 055, 95 per cent c.i. 036 to 084; P = 0012) and had fewer operations (ratio 051, 95 per cent c.i. 031 to 087; P = 0024) compared with those in the Hartmann's group. No difference was found in mean number of readmissions (137 versus 150; P = 0221) or mortality between patients randomized to laparoscopic lavage or Hartmann's procedure. Three patients in the lavage group and nine in the Hartmann's group had a colostomy at 24 months. ConclusionLaparoscopic lavage is a better option for perforated diverticulitis with purulent peritonitis than open resection and colostomy.

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