Trials of Surgical Treatment of Acute Perforated Diverticulitis: Finding What They Look For
Authors: Tim W. Eglinton, Frank A. Frizelle
Journal: Annals of Internal Medicine (2016)

Editorials2 February 2016Trials of Surgical Treatment of Acute Perforated Diverticulitis: Finding What They Look ForTim W. Eglinton, MBChB, MMedSc and Frank A. Frizelle, MBChB, MMedScTim W. Eglinton, MBChB, MMedScFrom University of Otago, Christchurch, Christchurch, New Zealand.Search for more papers by this author and Frank A. Frizelle, MBChB, MMedScFrom University of Otago, Christchurch, Christchurch, New Zealand.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-2788 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Most patients with acute diverticulitis are managed conservatively with intravenous antibiotics and improve without requiring acute surgery. When surgery is required, the Hartmann procedure, which involves sigmoid resection and end colostomy, is most commonly used. This procedure is associated with significant morbidity and stoma formation. Thus, an alternative to the Hartmann procedure that achieved at least an equivalent outcome would be welcome. However, the challenge is to define the outcomes that are important and to whom.In this issue, Thornell and colleagues (1) deserve congratulations for conducting a randomized, controlled trial called DILALA (DIverticulitis—LAparoscopic LAvage vs. resection [Hartman procedure] for ...References1. Thornell A, Angenete E, Bisgaard T, Bock D, Burcharth J, Heath J, et al. Laparoscopic lavage for perforated diverticulitis with purulent peritonitis. A randomized trial. Ann Intern Med. 2016;164:137-45. doi:10.7326/M15-1210 LinkGoogle Scholar2. Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Hewett PJ, Rieger NA, et al. Ethical issues with the disclosure of surgical trial short-term data. ANZ J Surg. 2011;81:125-31. [PMID: 21342382] doi:10.1111/j.1445-2197.2010.05433.x CrossrefMedlineGoogle Scholar3. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978;12:85-109. [PMID: 735943] MedlineGoogle Scholar4. O'Sullivan GC, Murphy D, O'Brien MG, Ireland A. Laparoscopic management of generalized peritonitis due to perforated colonic diverticula. Am J Surg. 1996;171:432-4. [PMID: 8604837] CrossrefMedlineGoogle Scholar5. Myers E, Hurley M, O'Sullivan GC, Kavanagh D, Wilson I, Winter DC. Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg. 2008;95:97-101. [PMID: 18076019] CrossrefMedlineGoogle Scholar6. Zeitoun G, Laurent A, Rouffet F, Hay J, Fingerhut A, Paquet J, et al. Multicentre, randomized clinical trial of primary versus secondary sigmoid resection in generalized peritonitis complicating sigmoid diverticulitis. Br J Surg. 2000;87:1366-74. [PMID: 11044163] CrossrefMedlineGoogle Scholar7. Vennix S, Musters GD, Mulder IM, Swank HA, Consten EC, Belgers EH, et al; Ladies trial colloborators. Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial. Lancet. 2015;386:1269-77. [PMID: 26209030] doi:10.1016/S0140-6736(15)61168-0 CrossrefMedlineGoogle Scholar8. Schultz JK, Yaqub S, Wallon C, Blecic L, Forsmo HM, Folkesson J, et al; SCANDIV Study Group. Laparoscopic lavage vs primary resection for acute perforated diverticulitis: the SCANDIV randomized clinical trial. JAMA. 2015;314:1364-75. [PMID: 26441181] doi:10.1001/jama.2015.12076 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Otago, Christchurch, Christchurch, New Zealand.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2788.Corresponding Author: Frank A. Frizelle, University of Otago, Christchurch, 2 Riccarton Avenue, Christchurch 8012, New Zealand; e-mail, Frank.[email protected]health.nz.Current Author Addresses: Drs. Eglinton and Frizelle: University of Otago, Christchurch, 2 Riccarton Avenue, Christchurch 8012, New Zealand.This article was published at www.annals.org on 19 January 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLaparoscopic Lavage for Perforated Diverticulitis With Purulent Peritonitis Anders Thornell , Eva Angenete , Thue Bisgaard , David Bock , Jakob Burcharth , Jane Heath , Hans-Christian Pommergaard , Jacob Rosenberg , Nikolaj Stilling , Stefan Skullman , and Eva Haglind Metrics Cited byNotfallmanagement der perforierten Sigmadivertikulitis und BlutungLaparoscopic Lavage in the Management of Hinchey Grade III DiverticulitisAcute colonic diverticulitis: modern understanding of pathomechanisms, risk factors, disease burden and severity 2 February 2016Volume 164, Issue 3Page: 195-196KeywordsAntibioticsColonComputed axial tomographyDiverticulitisLaparoscopyMorbidityPeritonitisSepsisSurgerySurgical resection ePublished: 19 January 2016 Issue Published: 2 February 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...