Laparoscopic peritoneal lavage versus sigmoidectomy for perforated diverticulitis with purulent peritonitis: three-year follow-up of the randomised LOLA trial

Vincent T Hoek; Pim P Edomskis; Pieter W Stark; Daniel P V Lambrichts; Werner A Draaisma; Esther C J Consten; Johan F Lange; Willem A Bemelman; LADIES trial collaborators

doi:10.1007/s00464-022-09326-3

Laparoscopic peritoneal lavage versus sigmoidectomy for perforated diverticulitis with purulent peritonitis: three-year follow-up of the randomised LOLA trial

Surg Endosc. 2022 Oct;36(10):7764-7774. doi: 10.1007/s00464-022-09326-3. Epub 2022 May 23.

Authors

Collaborators

LADIES trial collaborators:
W C Hop, B C Opmeer, J B Reitsma, R A Scholte, E W H Waltmann, A Legemate, J F Bartelsman, D W Meijer, M de Brouwer, J van Dalen, M Durbridge, M Geerdink, G J Ilbrink, S Mehmedovic, P Middelhoek, M J Boom, E C J Consten, J D W van der Bilt, G D J van Olden, M A W Stam, M S Verweij, Sandra Vennix, Gijsbert D Musters, Hilko A Swank, Marja A Boermeester, O R C Busch, C J Buskens, Y El-Massoudi, A B Kluit, C C van Rossem, M P Schijven, P J Tanis, C Unlu, Susan van Dieren, M F Gerhards, T M Karsten, L C de Nes, H Rijna, B A van Wagensveld, G I Koff Eman, E P Steller, J B Tuynman, S C Bruin, D L van der Peet, C F J M Blanken-Peeters, H A Cense, E Jutte, R M P H Crolla, G P van der Schelling, M van Zeeland, E J R de Graaf, R P R Groenendijk, T M Karsten, M Vermaas, O Schouten, M R de Vries, H A Prins, D J Lips, R J I Bosker, J A B van der Hoeven, J Diks, P W Plaisier, P M Kruyt, C Sietses, M W J Stommel, S W Nienhuijs, I H J T de Hingh, M D P Luyer, G van Montfort, E H Ponten, J F Smulders, E B van Duyn, J M Klaase, D J Swank, R T Ottow, H B A C Stockmann, J Vermeulen, R J C L M Vuylsteke, H J Belgers, S Fransen, E M von Meijenfeldt, M N Sosef, A A W van Geloven, E R Hendriks, B Ter Horst, M M N Leeuwenburgh, O van Ruler, J M Vogten, E J C Vriens, M Westerterp, Q A J Eijsbouts, A Bentohami, T S Bijlsma, N de Korte, D Nio, M J P M Govaert, J J A Joosten, R A E M Tollenaar, L P S Stassen, M J Wiezer, E J Hazebroek, A B Smits, H L van Westreenen, J F Lange, A Brandt, W N Nijboer, Irene M Mulder, B R Toorenvliet, W F Weidema, P P L O Coene, G H H Mannaerts, D den Hartog, R J de Vos, J F Zengerink, A G M Hoofwijk, K W E Hulsewé, J Melenhorst, J H M B Stoot, W H Steup, P J Huijstee, J W S Merkus, J J Wever, J K Maring, J Heisterkamp, W M U van Grevenstein, M R Vriens, M G H Besselink, I H M Borel Rinkes, A J Witkamp, G D Slooter, J L M Konsten, A F Engel, E G J M Pierik, T G Frakking, D van Geldere, G A Patijn, Belgium A J L D'Hoore, A van Overstraeten de Buck, M Miserez, I Terrasson, A Wolthuis, S di Saverio, M G de Blasiis

Affiliations

¹ Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. v.hoek@erasmusmc.nl.
² Department of Surgery, Erasmus University Medical Center, Wytemaweg 80 3015 CN Room Ee-173, Rotterdam, The Netherlands. v.hoek@erasmusmc.nl.
³ Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
⁴ Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
⁵ Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
⁶ Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
⁷ Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands.
⁸ Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

^# Contributed equally.

Abstract

Background: This study aimed to compare laparoscopic lavage and sigmoidectomy as treatment for perforated diverticulitis with purulent peritonitis during a 36 month follow-up of the LOLA trial.

Methods: Within the LOLA arm of the international, multicentre LADIES trial, patients with perforated diverticulitis with purulent peritonitis were randomised between laparoscopic lavage and sigmoidectomy. Outcomes were collected up to 36 months. The primary outcome of the present study was cumulative morbidity and mortality. Secondary outcomes included reoperations (including stoma reversals), stoma rates, and sigmoidectomy rates in the lavage group.

Results: Long-term follow-up was recorded in 77 of the 88 originally included patients, 39 were randomised to sigmoidectomy (51%) and 38 to laparoscopic lavage (49%). After 36 months, overall cumulative morbidity (sigmoidectomy 28/39 (72%) versus lavage 32/38 (84%), p = 0·272) and mortality (sigmoidectomy 7/39 (18%) versus lavage 6/38 (16%), p = 1·000) did not differ. The number of patients who underwent a reoperation was significantly lower for lavage compared to sigmoidectomy (sigmoidectomy 27/39 (69%) versus lavage 17/38 (45%), p = 0·039). After 36 months, patients alive with stoma in situ was lower in the lavage group (proportion calculated from the Kaplan-Meier life table, sigmoidectomy 17% vs lavage 11%, log-rank p = 0·0268). Eventually, 17 of 38 (45%) patients allocated to lavage underwent sigmoidectomy.

Conclusion: Long-term outcomes showed that laparoscopic lavage was associated with less patients who underwent reoperations and lower stoma rates in patients alive after 36 months compared to sigmoidectomy. No differences were found in terms of cumulative morbidity or mortality. Patient selection should be improved to reduce risk for short-term complications after which lavage could still be a valuable treatment option.

Trial registration: ClinicalTrials.gov NCT01317485.

Keywords: Complicated diverticulitis; Laparoscopic lavage.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Diverticulitis* / surgery
Diverticulitis, Colonic* / complications
Diverticulitis, Colonic* / surgery
Follow-Up Studies
Humans
Intestinal Perforation* / complications
Intestinal Perforation* / surgery
Laparoscopy* / adverse effects
Peritoneal Lavage / adverse effects
Peritonitis* / etiology
Peritonitis* / surgery
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01317485