Supplementary Material for: Longer term outcomes of laparoscopic peritoneal lavage in the management of acute Hinchey III perforated diverticulitis: A Systematic review and Meta-Analysis

Introduction:
To investigate the current evidence regarding long-term outcomes using laparoscopic peritoneal lavage (LPL) versus primary bowel resection (PR) in Hinchey III diverticulitis.

Methods:
A systematic review was undertaken based upon articles published between 1st January 2000 and 1st March 2024. Databases Pubmed, Scopus and Embase were used employing the key search terms “diverticulitis” and “peritoneal lavage”. Articles were selected according to the PRISMA guidelines and statistical analysis was undertaken. Cumulative analysis of diverticulitis recurrence and secondary outcomes of disease-related mortality, serious adverse events, stoma incidence, re-operation and re-admission rates were performed.

Results:
An initial search identified 506 articles for review. A total of 294 patients were included for final analysis from 3 prospective randomised controlled trials. There was no significant difference in disease-related mortality or serious adverse events between LPL and PR. There was significantly decreased likelihood of having a stoma in the LPL group however there was also a significantly increased likelihood of having recurrent diverticulitis. There was heterogenicity throughout.

Conclusion:
There is a paucity of level 1 evidence available regarding the long-term outcomes of Hinchey III diverticulitis managed with LPL. At 3-year follow-up there is a significantly decreased likelihood of having a stoma, tempered by the fact that there is a significantly increased likelihood of having recurrent diverticulitis. Further homogenous high-quality randomised studies are required to clarify whether LPL shows long term benefit.

引言：本研究旨在探究腹腔镜腹腔灌洗术（laparoscopic peritoneal lavage, LPL）与一期肠切除术（primary bowel resection, PR）治疗Hinchey Ⅲ型憩室炎（Hinchey III diverticulitis）的长期疗效相关现有证据。
方法：本研究针对2000年1月1日至2024年3月1日发表的文献开展系统综述。检索数据库涵盖PubMed、Scopus及Embase，检索关键词为“diverticulitis（憩室炎）”与“peritoneal lavage（腹腔灌洗）”。文献筛选严格遵循PRISMA指南，并完成统计学分析。本研究对憩室炎复发率、疾病相关死亡率、严重不良事件发生率、造口发生率、再手术率及再入院率等次要结局指标进行了汇总分析。
结果：初步检索共筛选出506篇待审文献。最终从3项前瞻性随机对照试验中纳入294例患者完成最终分析。腹腔镜腹腔灌洗术组与一期肠切除术组的疾病相关死亡率及严重不良事件发生率无显著差异。相较于一期肠切除术组，腹腔镜腹腔灌洗术组患者造口形成风险显著降低，但憩室炎复发风险却显著升高。研究整体存在统计学异质性。
结论：目前关于腹腔镜腹腔灌洗术治疗Hinchey Ⅲ型憩室炎的长期疗效的一级证据较为匮乏。在3年随访周期内，腹腔镜腹腔灌洗术可显著降低造口形成风险，但这一获益被憩室炎复发风险显著升高这一事实所抵消。未来仍需开展同质化高质量随机对照研究，以明确腹腔镜腹腔灌洗术是否具备长期临床获益。