Two-stage laparoscopic management of generalized peritonitis due to perforated sigmoid diverticula: Eighteen cases

The classic treatment of generalized peritonitis due to perforation of sigm oid diverticula is based on the principle of a two-stage surgery with a tem porary derivation of the colonic transit. This procedure is associated with a prohibitively high immediate and delayed morbidity, especially associate d with the abdominal wound. The laparoscopic approach to this complication is less aggressive and allows a second-stage elective laparoscopic resectio n. Eighteen consecutive patients (ten women and eight men; average age, 53. 7 years) underwent emergency laparoscopic treatment for generalized periton itis due to perforated diverticula. Eight of these patients had previously had diverticulitis attacks. By peritoneal cavity exploration and full perit oneal lavage (average, 15 L), the infected sigmoid lesion was stuck with bi ologic glue. A drain was inserted at the site of the lesion and in some cas es also in other abdominal zones, No colostomy was necessary. Antibiotic tr eatment was started at diagnosis and continued for a minimum of 7 days. The re was no mortality. Morbidity was limited to three patients (two cases of lymphangitis and one of pulmonary disease). No patient had a wound abscess or residual deep collections. The mean hospitalization was 8 days. Fourteen patients underwent elective laparoscopic sigmoid resection with a delay of 3.5 months. One conversion to laparotomy was necessary. The laparoscopic t reatment of generalized peritonitis due to perforated sigmoid diverticula i s an interesting alternative to the traditional treatment. It is associated with a lower morbidity, a shorter postoperative hospital stay, and an impr ovement in the patient's quality of life, because colostomy is avoided. It is also associated with economic savings.