Laparoscopic peritoneal lavage versus sigmoidectomy for perforated diverticulitis with purulent peritonitis: three-year follow-up of the randomised LOLA trial
Authors: Hoek Vincent T. , Edomskis Pim P. , Stark Pieter W. , Lambrichts Daniel P. V. , Draaisma Werner A. , Consten Esther C. J. , Lange Johan F. , Bemelman Willem A. ,   The LADIES trial collaborators, Hop W C , Opmeer B C , Reitsma J B , Scholte R A , Waltmann E W H , Legemate A , Bartelsman J F , Meijer D W , de Brouwer M , van Dalen J , Durbridge M , Geerdink M , Ilbrink G J , Mehmedovic S , Middelhoek P , Boom M J , Consten E C J , van der Bilt J D W , van Olden G D J , Stam M A W , Verweij M S , Vennix Sandra , Musters Gijsbert D , Swank Hilko A , Boermeester Marja A , Busch O R C , Buskens C J , El-Massoudi Y , Kluit A B , van Rossem C C , Schijven M P , Tanis P J , Unlu C , van Dieren Susan , Gerhards M F , Karsten T M , de Nes L C , Rijna H , van Wagensveld B A , Koff eman G I , Steller E P , Tuynman J B , Bruin S C , van der Peet D L , Blanken-Peeters C F J M , Cense H A , Jutte E , Crolla R M P H , van der Schelling G P , van Zeeland M , de Graaf E J R , Groenendijk R P R , Karsten T M , Vermaas M , Schouten O , de Vries M R , Prins H A , Lips D J , Bosker R J I , van der Hoeven J A B , Diks J , Plaisier P W , Kruyt P M , Sietses C , Stommel M W J , Nienhuijs S W , de Hingh I H J T , Luyer M D P , van Montfort G , Ponten E H , Smulders J F , van Duyn E B , Klaase J M , Swank D J , Ottow R T , Stockmann H B A C , Vermeulen J , Vuylsteke R J C L M , Belgers H J , Fransen S , von Meijenfeldt E M , Sosef M N , van Geloven A A W , Hendriks E R , ter Horst B , Leeuwenburgh M M N , van Ruler O , Vogten J M , Vriens E J C , Westerterp M , Eijsbouts Q A J , Bentohami A , Bijlsma T S , de Korte N , Nio D , Govaert M J P M , Joosten J J A , Tollenaar R A E M , Stassen L P S , Wiezer M J , Hazebroek E J , Smits A B , van Westreenen H L , Lange J F , Brandt A , Nijboer W N , Mulder Irene M , Toorenvliet B R , Weidema W F , Coene P P L O , Mannaerts G H H , den Hartog D , de Vos R J , Zengerink J F , Hoofwijk A G M , Hulsewé K W E , Melenhorst J , Stoot J H M B , Steup W H , Huijstee P J , Merkus J W S , Wever J J , Maring J K , Heisterkamp J , van Grevenstein W M U , Vriens M R , Besselink M G H , Borel Rinkes I H M , Witkamp A J , Slooter G D , Konsten J L M , Engel A F , Pierik E G J M , Frakking T G , van Geldere D , Patijn G A , D’Hoore Belgium A J L , de Buck A van Overstraeten , Miserez M , Terrasson I , Wolthuis A , di Saverio S , de Blasiis M G 
Published: May 2022

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.

Graphical abstract