Longer term outcomes of laparoscopic peritoneal lavage in the management of acute Hinchey III perforated diverticulitis: A Systematic review and Meta-Analysis.

Introduction: To investigate the current evidence regarding long-term outcomes using laparoscopic peritoneal lavage (LPL) versus primary bowel resection (PR) in Hinchey III diverticulitis.

Methods: A systematic review was undertaken based upon articles published between 1st January 2000 and 1st March 2024. Databases Pubmed, Scopus and Embase were used employing the key search terms "diverticulitis" and "peritoneal lavage". Articles were selected according to the PRISMA guidelines and statistical analysis was undertaken. Cumulative analysis of diverticulitis recurrence and secondary outcomes of disease-related mortality, serious adverse events, stoma incidence, re-operation and re-admission rates were performed.

Results: An initial search identified 506 articles for review. A total of 294 patients were included for final analysis from 3 prospective randomised controlled trials. There was no significant difference in disease-related mortality or serious adverse events between LPL and PR. There was significantly decreased likelihood of having a stoma in the LPL group however there was also a significantly increased likelihood of having recurrent diverticulitis. There was heterogenicity throughout.

Conclusion: There is a paucity of level 1 evidence available regarding the long-term outcomes of Hinchey III diverticulitis managed with LPL. At 3-year follow-up there is a significantly decreased likelihood of having a stoma, tempered by the fact that there is a significantly increased likelihood of having recurrent diverticulitis. Further homogenous high-quality randomised studies are required to clarify whether LPL shows long term benefit.