Surgery Still Best Treatment for Perforated Diverticulitis

Background:  Observational studies have suggested lap peritoneal lavage may be better than resection for perfed diverticulitis.
Sweden/Norway study, n=199 patients presenting with diverticulitis with free air on CT.
Severe post-op complications were similar in both groups (31% lavage v 26% resection), mortality at 90 d (14% v 12%), LOS and QOL.  Rates of reoperation higher in lavage group, 4 of which required reoperation for missed sigmoid cancers.
Conclusion:  Resection for perfed diverticulitis is superior.
JAMA 2015 Oct 6; 314:1364
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