**8. Laparoscopy in the perforation of diverticular disease of the colon**

Perforation of diverticular colon disease, generally in the sigmoid colon, with localized contamination of the abdominal cavity can be treated with antibiotics during the early stages, but abscesses larger than 5 cm must be approached surgically. Sigmoidectomy is indicated in patients who have suffered at least 2 crises of diverticulitis and in patients younger than 50 years who have suffered only one episode (Saeurland et al.,2006). Even within an urgency context, this surgery can be performed by the laparoscopic route with a surgical time and results comparable to those of laparotomy and has been performed with a conversion rate of 10% (Tonelli et al., 2009).

Over the last few years, there has been an increased use of peritoneal washing and drainage of the cavity by the laparoscopic route without resection, allied to antibiotic treatment during the episode of peritonitis secondary to diverticular perforation. Definite treatment by colectomy can be performed in an elective manner after the resolution of the inflammatory process (Saeurland et al., 2006; Tonelli et al., 2009).

In a systematic literature review of 231 cases of acute diverticulitis with purulent peritonitis treated in this manner, abdominal sepsis was effectively controlled in 95.7% of the patients. Mortality was 1.7%, morbidity was 10.4% and 1.7% of the patients required a stoma. A long recurrence-free period of time was observed in the patients not subjected to colon resection, and later elective resection of the segment involved by the laparoscopic route was possible in most cases (Toorenvliet et al., 2010).

Laparoscopic Approach to Abdominal Sepsis 233

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