More Re-operations, Missed Cancers in Lavage Procedure For Perforated Diverticulitis

 Prof. Tom Øresland and  Johannes Schultz

Prof. Tom Øresland and
Dr. Johannes Schultz Interview with:
Johannes Kurt Schultz, MD
Department of Gastrointestinal Surgery
Akershus University Hospital, Lørenskog, Norway
Faculty of Medicine, University of Oslo, Oslo, Norway 

Medical Research: What is the background for this study? What are the main findings?

Dr. Schultz: Acute perforated diverticulitis is a serious condition requiring urgent surgical attention. Laparoscopic peritoneal lavage has been described as a tempting option in treatment of these patients instead of today’s standard management with resection of the diseased bowel segment. Previous non-randomized studies have suggested that this novel mini-invasive approach is superior to traditional surgery. Our randomized trial is the largest study conducted to investigate these two treatment options. We demonstrate that the new treatment is not superior to the established surgical management. In fact, the reoperation rate in the laparoscopic lavage group was higher and some sigmoid cancers were not identified in the lavage group and thus left in-situ.

Medical Research: What should clinicians and patients take away from your report?

Dr. Schultz: Our findings emphasize the importance of randomized trials, especially when introducing new surgical treatments. It seems like earlier publications were largely affected by selection bias. Clinicians should bare that in mind when implementing new procedures. Our results do not support laparoscopic lavage as a treatment of choice for patients with perforated diverticulitis with purulent contamination of the abdomen.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Schultz: In order to determine the role of laparoscopic lavage in the treatment of perforated diverticulitis, further studies will have to focus on which subpopulation of patients with perforated diverticulitis might benefit from this procedure. We are currently analyzing results from long-term follow-up which may further enlighten the possible use of laparoscopic lavage.


Schultz J, Yaqub S, Wallon C, et al. Laparoscopic Lavage vs Primary Resection for Acute Perforated Diverticulitis: The SCANDIV Randomized Clinical Trial. JAMA.2015;314(13):1364-1375. doi:10.1001/jama.2015.12076.

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Johannes Kurt Schultz, MD (2015). More Re-operations, Missed Cancers in Lavage Procedure For Perforated Diverticulitis

Last Updated on October 7, 2015 by Marie Benz MD FAAD