Encompassing an Emerging Laparoscopic Surgical Procedure for Hinchey III Diverticulitis Into Acute Surgical Care Practice: Our Experience With a Case Report and Review of Literature

Abstract

In the past decade, there has been emerging data from the West supporting the use of laparoscopic lavage (LL) as a minimally invasive surgical (MIS) technique to treat Hinchey III perforated diverticulitis, rather than previous standard open surgical resection procedures. However, this can only be used in a select group of patients and also requires adequate knowledge and experience of colorectal and MIS techniques. This approach remains novel and rarely practiced in Asia. In this report, we review the current literature and discuss the considerations, outcomes, and limitations of this technique with an illustration of our case report. We report on a case of Hinchey III diverticulitis in a 51-year-old Asian woman who was successfully treated with LL after initial diagnostic laparoscopy in our institution and was discharged on the fifth postoperative day. LL is a colorectal MIS technique that has been evaluated and appears to be effective and has less morbidity compared with Hartmann procedure or primary resection with anastomosis. This technique should be incorporated into our practice for patients with Hinchey III diverticulitis who are suitable for laparoscopy at presentation. With the management of our case, we hence propose a clinical algorithm for adoption of this MIS technique by advocating routine diagnostic laparoscopy in hemodynamically stable patients presenting with gross peritonitis from perforated diverticulitis. This will promote the adoption of LL as a management option for perforated diverticulitis.