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Comment & Response
March 8, 2016

Laparoscopic Lavage vs Primary Resection for Perforated Diverticulitis

Author Affiliations
  • 1Northwest Permanente, Vancouver, Washington
JAMA. 2016;315(10):1052-1053. doi:10.1001/jama.2015.17867

To the Editor Dr Schultz and colleagues1 studied laparoscopic lavage vs colon resection for perforated diverticulitis. They reported no differences in severe postoperative complications, and 20% of patients needed further surgery after a laparoscopic lavage vs 6% after resection.

Should reoperation after a laparoscopic lavage be considered a complication? If having to perform a Hartmann procedure later in the patient’s treatment was considered a complication for the lavage group, then should not all primary Hartmann procedures have been considered complications as well? A Hartmann procedure is a morbid surgery requiring a large laparotomy. This procedure has long-term risks of incisional hernia, small-bowel obstruction, and colostomy (which will require a second major laparotomy for restoration of intestinal continuity). In the resection group, 70% of patients had this procedure up front.

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