Laparoscopic lavage in Swedish routine care 2016-2018. The LapLav study

Abstract

Aim: The aim of the thesis was to compare laparoscopic lavage with resection surgery for perforated diverticulitis. Method: All patients operated for perforated diverticulitis in Sweden between 2016-2018 were identified through the national In-Patient Registry. Data from medical records and a few other registers were used. All patients alive after 2-3 years were invited to answer a questionnaire regarding function and well-being. Results: Paper I found that lavage resulted in a lower complication burden and shorter length of hospital stay. Paper II evaluated functional outcomes and quality of life. There were few differences between the groups and both groups reported a high level of distress due to dysfunction. In paper III the primary outcome of “additional surgery” was reported. The lavage group had fewer additional operations. Further, 27% of the lavage patients had resection surgery during the two-year follow-up. Paper IV compared Hinchey IV patients with Hinchey III. Mortality was higher for the Hinchey IV group. However, sepsis was a stronger predictor for death than the Hinchey grade. Conclusion: Laparoscopic lavage is a feasible and safe method to surgically treat perforated diverticulitis, Hinchey grade III, in routine care. Sepsis is a strong mediator of death and should be taken into consideration.