Intérêt du lavage-drainage laparoscopique des péritonites sigmoïdiennes Hinchey III

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Objective: To evaluate laparoscopic lavage (LL) compared to the Hartmann (H) procedure for the treatment of Hinchey III purulent diverticular peritonitis. Background: Laparoscopic lavage is a recent treatment for Hinchey III peritonitis, which has experienced strong development, but recent publications question this technique. Method: This is a monocentric retrospective study performed at Grenoble University Hospital. All patients who underwent Hinchey III perforated diverticulitis were included. We compared the techniques used: laparoscopic lavage (LL), Hartmann intervention (H) and resection anastomosis. The primary endpoint was postoperative morbidity and mortality according to Dindo Clavien (DC). Secondary outcomes were duration of hospitalization, readmission rate at 90 days, and final stoma rate. Results: Between 2004 and 2017, 122 patients underwent emergency surgery for sigmoiditis at Grenoble University Hospital, including 90 Hinchey III peritonitis. 56 (62.2%) patients received LL and 34 (37.8%) had Hartmann surgery Patients in the LL group had a lower ASA score and less severe peritonitis. The serious morbidity rate (DC>=3) was 26.8% for the LL group and 58.8% for the H group (p = 0.0051). The mortality rate was 1.8% for the LL group and 23.5% for the H group (p = 0.0030). The duration of hospitalization was shorter in the LL group (11 days (IQR 8-17) versus 18 days (IQR 14-27) for H p <0.0001). The final stoma rate was lower in the LL group (17.8% vs 60.6% p <0.0001). There was no difference between the two groups on the 90-day readmission rate. Conclusion: The laparoscopic lavage technique can still be used for the treatment of Hinchey III peritonitis in selected patients.

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