Authors’ reply: Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis (Br J Surg 2008; 95: 97–101)

Sir We thank Drs Essani and Bergamaschi for their interest in laparoscopic lavage (without resection) for generalised peritonitis due to perforated diverticulitis. Whether our colleagues are open to change or not, positive experiences from several hospitals have been published in journals on both sides of the Atlantic1,2. Our multicentre study of 100 patients found better morbidity (4 per cent) and mortality (3 per cent) than historical resection. Reviewers correctly identified the respect given to previous literature and a balanced presentation of facts rather than opinion or self-promotion. We are confused by the suggestion there is ‘evidence’ that resection for perforated diverticulitis is advantageous when the limited literature is actually either equivocal or to the contrary. In the referenced trial of 105 patients (1986–1996) ‘non-resection’ (laparotomy and colostomy) had a clinically and statistically similar mortality (19 versus 24 per cent)3. Another randomized trial (also underpowered) found open non-resection surgery had a lower mortality risk than resection4. Not only does this do little to detract from the excellent results with laparoscopic lavage (hardly a ‘sham’ operation), it positively reinforces the moral, ethical, and professional need to challenge current practice.