Laparoscopic Lavage for XXXX With @entity298 : A Randomized Trial.

@entity1 @entity2928 @entity298 @entity4436
Background: Perforated @entity4436 with @entity298 has traditionally been treated with open colon resection and stoma formation with risk for reoperations, morbidity, and mortality. Laparoscopic lavage alone has been suggested as definitive treatment. Objective: To compare laparoscopic lavage with open colon resection and colostomy (Hartmann procedure) for @entity4436 with @entity298 . Design: Randomized, controlled, multicenter, open-label trial. (ISRCTN registry number: ISRCTN82208287). Setting: 9 hospitals in Sweden and Denmark. @entity1 : @entity1 who have confirmed Hinchey grade III @entity4436 with @entity298 at diagnostic laparoscopy. Intervention: Randomization between laparoscopic lavage and the Hartmann procedure. Measurements: Primary outcome was the percentage of @entity1 having 1 or more reoperations within 12 months. Key secondary outcomes were number of reoperations, hospital readmissions, total length of hospital stay during 12 months, and adverse events. Results: A total of 43 and 40 @entity1 were randomly assigned to laparoscopic lavage and the Hartmann procedure with a median (first, third quartiles) follow-up of 372 days (336, 394) and 378 days (226, 396), respectively. Fewer @entity1 in the laparoscopic group (12 of 43; 27.9%) than in the Hartmann group (25 of 40; 62.5%) had at least 1 reoperation within 12 months (relative risk reduction, 59%; relative risk, 0.41 [95% CI, 0.23 to 0.72]; P  = 0.004). Mortality and severe adverse events did not differ between groups. Total length of hospital stay (days) within 12 months was shorter for the laparoscopic group than the Hartmann group, with a reduction of 35% (relative risk, 0.65 [CI, 0.45 to 0.94]; P  = 0.047). After 12 months, 3 @entity1 in the laparoscopic group and 11 in the Hartmann group had a stoma. Limitation: Not all @entity1 presenting with suspected @entity4436 were enrolled. Conclusion: Laparoscopic lavage reduced the need for reoperations, had a similar safety profile to the Hartmann procedure, and may be an appropriate treatment of choice for acute @entity4436 with @entity298 . Primary Funding Source: @entity2928 ; Sahlgrenska University Hospital, Gothenburg.
