“Acute perforated diverticulitis with peritonitis is a feared complication of diverticular disease. The incidence in Western countries is estimated to be 1.85 per 100 000 population per year for purulent peritonitis. Even with optimal treatment, perforated diverticulitis has a high morbidity and mortality. Traditionally, the standard treatment has been emergency surgery with resection of the diseased bowel, often with colostomy creation. Studies have indicated that laparoscopic lavage with drainage and antibiotics might be a treatment option in perforated diverticulitis. So far, 3 European randomized clinical trials have shown somewhat different results, and no clear advantages have been demonstrated with laparoscopic lavage, except a lower stoma rate at 1-year follow-up. Nine meta-analyses and systematic reviews of the short-term and 1-year results of these trials have been published in the last 4 years, with divergent conclusions. No long-term results on laparoscopic lavage have yet been published.”

“The present long-term results (median follow-up, 59 months) of the SCANDIV trial, the largest completed randomized clinical trial (to the authors’ knowledge) comparing laparoscopic lavage with sigmoid resection in acute perforated purulent diverticulitis, demonstrate no significant difference in severe complications or overall mortality between the 2 treatment groups. However, there were more unplanned reoperations, unplanned readmissions, and recurrence of diverticulitis in the laparoscopic lavage group. Nearly
one-third of patients (30%) in the laparoscopic lavage group ended up with a sigmoid resection. Not surprisingly, the overall stoma prevalence was remarkably lower in the laparoscopic lavage group. The proportions of secondary operations, when stoma reversals were included, were similar in both groups. No significant differences in QoL and functional outcomes were observed, although there was a nonsignificant difference of more pain and immobility in the resection group. However, the SCANDIV trial may have been underpowered to detect an actual difference in these dimensions of QoL.”

Azhar, Najia et al. “Laparoscopic Lavage vs Primary Resection for Acute Perforated Diverticulitis: Long-term Outcomes From the Scandinavian Diverticulitis (SCANDIV) Randomized Clinical Trial.” JAMA surgery vol. 156,2 (2021): 121-127. Free Full Text