Introduction. The complications of diverticulosis occurs in 40–42% of patients, of them diverticulum perforation is observed in 3.3% in cases of the clinically expressed and asymptomatic types of the disease. In 1996, O’Sullivan proposed a procedure for laparoscopic peritoneal lavage and drainage (LLD) in patients with diffuse purulent peritonitis after perforation of the diverticulum in the absence of massive fecal contamination of the abdominal cavity. LLD should be considered as an effective and safe treatment option for patients according to the Hinchey III classification, which avoids Hartmann’s operation. The number of complications in this case is 35–38%, lethality — 5–7.1%.
Aims. To evaluate the technique of laparoscopic peritoneal lavage in the treatment of complicated colonic diverticular disease.
Materials and methods. For 2004–2017 years has been making the analysis of treatment of 129 patients, who were performed 141 operations for the colonic diverticular disease and its complications in the Military Medical Clinical Center of the Southern Region in Odessa. The men were 72 (55.8%), women 57 (44.2%). Complicated forms of colonic diverticular disease were diagnosed in 110 (86.0%) patients. Acute diverticulitis with inflammatory changes in the wall of the colon was diagnosed in 36 (32.4 %) people, diverticulum perforation — 57 (51.4%) patients, intestinal bleeding — in 12 (10.8%) patients, Intestinal fistulas — in 5 (5.4%) patients. In urgent order were performed 105 (74.4%) operations, 43 of them (41.4%) — by using videoendoscopy equipment, 62 (58.6%) operations — the traditional open method.
Results. When patients with a clinical picture of unrestricted peritonitis were performed diagnostic laparoscopy — 61, which passed to therapeutic laparoscopy in 26 patients, laparoscopic peritoneal lavage was performed in 23 patients, open operations — 12. The middle amount of bed-day for Hartmann’s operation was (12.0±2.1) days; formation of the primary anastomosis — (13.0±3.1) days; laparoscopic peritoneal lavage with dranaige — 7.0±1.9 days. The number of complications in LLD — 4 (17.4%) (Hartmann’s operation — 10 (31.3%), primary anastomoses — 4 (25.0%)). The lack of mortality (in the operation of Hartmann was 5 patients (15.6%), with primary anastomoses with stoma or without it — 1 (6.25%).
Conclusions. Performing laparoscopic peritonial lavage in patients with perforated diverticulitis complicated by purulent peritonitis is an alternative to Hartmann’s operation or intestinal resection with a primary anastomosis (with a preventive stoma), which is based on a lower mortality and fewer complications and reduced bed-days.