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Laparoscopic lavage for Hinchey III perforated diverticulitis : factors for treatment failure in two randomized clinical trials

Azhar, Najia LU orcid ; Lambrichts, Daniël ; Lange, Johan ; Yaqub, Sheraz ; Øresland, Tom ; Schultz, Johannes LU ; Bemelman, Willem and Buchwald, Pamela LU (2023) In The British journal of surgery 110(7). p.846-851
Abstract

BACKGROUND: The Scandinavian Diverticulitis (SCANDIV) trial and the LOLA arm of the LADIES trial randomized patients with Hinchey III perforated diverticulitis to laparoscopic peritoneal lavage or sigmoid resection. The aim of this analysis was to identify risk factors for treatment failure in patients with Hinchey III perforated diverticulitis.

METHODS: This was a post hoc analysis of the SCANDIV trial and LOLA arm. Treatment failure was defined as morbidity requiring general anaesthesia (Clavien-Dindo grade IIIb or higher) within 90 days. Age, sex, BMI, ASA fitness grade, smoking status, previous episodes of diverticulitis, previous abdominal surgery, time to surgery, and surgical competence were all tested in univariable and... (More)

BACKGROUND: The Scandinavian Diverticulitis (SCANDIV) trial and the LOLA arm of the LADIES trial randomized patients with Hinchey III perforated diverticulitis to laparoscopic peritoneal lavage or sigmoid resection. The aim of this analysis was to identify risk factors for treatment failure in patients with Hinchey III perforated diverticulitis.

METHODS: This was a post hoc analysis of the SCANDIV trial and LOLA arm. Treatment failure was defined as morbidity requiring general anaesthesia (Clavien-Dindo grade IIIb or higher) within 90 days. Age, sex, BMI, ASA fitness grade, smoking status, previous episodes of diverticulitis, previous abdominal surgery, time to surgery, and surgical competence were all tested in univariable and multivariable logistic regression analyses using an interaction variable.

RESULTS: The pooled analysis included 222 patients randomized to laparoscopic lavage and primary resection (116 and 106 patients respectively). Univariable analysis found ASA grade to be associated with advanced morbidity in both groups, and the following factors in the laparoscopic lavage group: smoking, corticosteroid use, and BMI. Significant factors for laparoscopic lavage morbidity in multivariable analysis were smoking (OR 7.05, 95 per cent c.i. 2.07 to 23.98; P = 0.002) and corticosteroid use (OR 6.02, 1.54 to 23.51; P = 0.010).

CONCLUSION: Active smoking status and corticosteroid use were risk factors for laparoscopic lavage treatment failure (advanced morbidity) in patients with perforated diverticulitis.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The British journal of surgery
volume
110
issue
7
pages
846 - 851
publisher
Oxford University Press
external identifiers
  • scopus:85164435392
  • pmid:37202860
ISSN
1365-2168
DOI
10.1093/bjs/znad114
language
English
LU publication?
yes
additional info
© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.
id
8eadbab8-69f4-4595-afe2-9392874a4510
date added to LUP
2023-05-22 16:49:33
date last changed
2024-04-19 22:02:40
@article{8eadbab8-69f4-4595-afe2-9392874a4510,
  abstract     = {{<p>BACKGROUND: The Scandinavian Diverticulitis (SCANDIV) trial and the LOLA arm of the LADIES trial randomized patients with Hinchey III perforated diverticulitis to laparoscopic peritoneal lavage or sigmoid resection. The aim of this analysis was to identify risk factors for treatment failure in patients with Hinchey III perforated diverticulitis.</p><p>METHODS: This was a post hoc analysis of the SCANDIV trial and LOLA arm. Treatment failure was defined as morbidity requiring general anaesthesia (Clavien-Dindo grade IIIb or higher) within 90 days. Age, sex, BMI, ASA fitness grade, smoking status, previous episodes of diverticulitis, previous abdominal surgery, time to surgery, and surgical competence were all tested in univariable and multivariable logistic regression analyses using an interaction variable.</p><p>RESULTS: The pooled analysis included 222 patients randomized to laparoscopic lavage and primary resection (116 and 106 patients respectively). Univariable analysis found ASA grade to be associated with advanced morbidity in both groups, and the following factors in the laparoscopic lavage group: smoking, corticosteroid use, and BMI. Significant factors for laparoscopic lavage morbidity in multivariable analysis were smoking (OR 7.05, 95 per cent c.i. 2.07 to 23.98; P = 0.002) and corticosteroid use (OR 6.02, 1.54 to 23.51; P = 0.010).</p><p>CONCLUSION: Active smoking status and corticosteroid use were risk factors for laparoscopic lavage treatment failure (advanced morbidity) in patients with perforated diverticulitis.</p>}},
  author       = {{Azhar, Najia and Lambrichts, Daniël and Lange, Johan and Yaqub, Sheraz and Øresland, Tom and Schultz, Johannes and Bemelman, Willem and Buchwald, Pamela}},
  issn         = {{1365-2168}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{7}},
  pages        = {{846--851}},
  publisher    = {{Oxford University Press}},
  series       = {{The British journal of surgery}},
  title        = {{Laparoscopic lavage for Hinchey III perforated diverticulitis : factors for treatment failure in two randomized clinical trials}},
  url          = {{http://dx.doi.org/10.1093/bjs/znad114}},
  doi          = {{10.1093/bjs/znad114}},
  volume       = {{110}},
  year         = {{2023}},
}