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Laparoscopic Peritoneal Lavage or Resection for Generalised Peritonitis for Perforated Diverticulitis (Ladies)

Primary Purpose

Perforated Diverticulitis

Status
Unknown status
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Laparoscopic lavage and drainage
Sigmoidectomy with primary anastomosis
Sigmoidectomy with end-colostomy
Sponsored by
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Perforated Diverticulitis focused on measuring diverticulitis, perforation, sigmoidectomy, sigmoid resection, lavage, laparoscopic, wash-out, rinsing, hartmann, end-colostomy, primary anastomosis

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

patients suspected of diverticulitis

  • age in between 18 and 85 years old
  • with written informed consent
  • with free air on plain abdominal or thoracic X-ray or CT-scan OR with peritonitis and diffuse gas or fluid on CT-scan

Exclusion Criteria:

  • dementia
  • prior sigmoidectomy
  • steroid treatment > 20 mg daily
  • prior pelvic irradiation
  • preoperative shock: requirement of inotropics due to circulatory insufficiency

Sites / Locations

  • University Clinic St. Luc
  • University Hospital LeuvenRecruiting
  • Jeroen Bosch HospitalRecruiting
  • Flevo HospitalRecruiting
  • Rijnland Hospital
  • Meander Medical CentreRecruiting
  • Academic Medical CentreRecruiting
  • Free University Medical CentreRecruiting
  • Onze Lieve Vrouwe HospitalRecruiting
  • Slotervaart HospitalRecruiting
  • St. Lucas Andreas HospitalRecruiting
  • Alysis Medical CentreRecruiting
  • Rode Kruis HospitalRecruiting
  • Amphia HospitalRecruiting
  • IJsselland HospitalRecruiting
  • Reinier de Graaf HospitalRecruiting
  • Deventer Hospital
  • Albert Schweitzer HospitalRecruiting
  • Gelderse Vallei HospitalRecruiting
  • Catharina HospitalRecruiting
  • Medical Spectrum TwenteRecruiting
  • Groene Hart HospitalRecruiting
  • Kennemer HospitalRecruiting
  • Atrium Medical CentreRecruiting
  • Tergooi HospitalsRecruiting
  • Spaarne HospitalRecruiting
  • Westfries HospitalRecruiting
  • Leiden University Medical Centre
  • Maastricht University Medical CentreRecruiting
  • St. Antonius HospitalRecruiting
  • Erasmus Medical CentreRecruiting
  • Ikazia HospitalRecruiting
  • Maasstad HospitalRecruiting
  • St. Franciscus HospitalRecruiting
  • Orbis Medical CentreRecruiting
  • Haga HospitalRecruiting
  • Twee Steden HospitalRecruiting
  • University Medical Centre UtrechtRecruiting
  • Máxima Medical CentreRecruiting
  • Zaans Medical CentreRecruiting
  • Isala HospitalsRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Purulent peritonitis

Fecal peritonitis or overt perforation

Arm Description

Patients with purulent peritonitis are randomised at a 2:1:1 ratio between Laparoscopic lavage and drainage Sigmoidectomy with primary anastomosis Sigmoidectomy with end-colostomy

Patients with fecal peritonitis or an overt perforation are randomised between Sigmoidectomy with primary anastomosis Sigmoidectomy with end-colostomy

Outcomes

Primary Outcome Measures

Mortality and major morbidity (combined)
The primary outcome in the lavage vs. resectional intervention comparison (LOLA), will be poor clinical outcome, defined as a combined endpoint consisting of mortality and major morbidity one year after initial surgery. Major morbidity includes any of the following events or conditions: reintervention, wound dehiscence, incisional hernia, abscess needing percutaneous drainage, urosepsis, myocardial infarction, renal failure and respiratory insufficiency.
Stoma-free survival
Stoma-free survival one year after initial surgery, is the primary outcome for the comparison of the resectional strategies (DIVA).

Secondary Outcome Measures

Operating time
Hospital stay
Number of days alive and outside the hospital
Incisional hernia
Reinterventions
All reinterventions within a one year time frame, including percutaneous abscess drainage.
Health related quality of life
SF-36, EQ-5D, GIQLI measured at 2, 4, 13 and 26 weeks after primary surgery.
Health care utilisation and associated costs
SF-HLQ measured at 4, 13, 26, 39 and 52 weeks after primary surgery

Full Information

First Posted
March 16, 2011
Last Updated
March 20, 2014
Sponsor
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Collaborators
ZonMw: The Netherlands Organisation for Health Research and Development
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1. Study Identification

Unique Protocol Identification Number
NCT01317485
Brief Title
Laparoscopic Peritoneal Lavage or Resection for Generalised Peritonitis for Perforated Diverticulitis
Acronym
Ladies
Official Title
Laparoscopic Peritoneal Lavage or Resection for Generalised Peritonitis for Perforated Diverticulitis: a Nationwide Multicenter Randomised Trial
Study Type
Interventional

2. Study Status

Record Verification Date
March 2014
Overall Recruitment Status
Unknown status
Study Start Date
April 2010 (undefined)
Primary Completion Date
March 2017 (Anticipated)
Study Completion Date
March 2017 (Anticipated)

3. Sponsor/Collaborators

Name of the Sponsor
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Collaborators
ZonMw: The Netherlands Organisation for Health Research and Development

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The first objective (LOLA) of this integrated trial is to determine whether laparoscopic lavage leads to better clinical outcomes compared to sigmoidectomy in patients with perforated diverticulitis with purulent peritonitis in terms of mortality and major morbidity. The second objective (DIVA) is to determine whether sigmoidectomy with anastomosis or sigmoidectomy with end-colostomy is the superior approach in patients with perforated diverticulitis with either purulent or faecal peritonitis in terms of stoma free survival. The study is designed as a multicenter and randomised trial.
Detailed Description
Patients diagnosed as having perforated diverticulitis with free air on plain abdominal X-ray or CT scan fulfilling the in- and exclusion criteria are randomised during laparoscopy via a central computer. In case of purulent diverticulitis patients are randomised to three arms: (a) laparoscopic lavage, (b) sigmoidectomy with colostomy or (c) sigmoidectomy with anastomosis in ratio of 2:1:1. In case of faecal peritonitis or an overt perforation of the sigmoid, the patient will be randomised 1:1 to sigmoidectomy with colostomy or sigmoidectomy with primary anastomosis. The first primary outcome parameter consists of a combined endpoint consisting of mortality and major morbidity (LOLA). The second primary endpoint consists of stoma-free survival one year after initial surgery (DIVA). Secondary endpoints are number of days alive and outside the hospital, health related quality of life, health care utilisation and associated costs. A sample size of 132:66:66 patients per treatment arm will be able to detect a difference in the combined endpoint of serious complications and mortality from 25% in the two sigmoidectomy groups compared to 10% in the lavage group (two-side alpha of 5% and a power of 90%. In the DIVA analysis 2x132 patients are needed to significantly demonstrate a difference of 30% in stoma-free survival between both treatment arms (log rank test two-sided alpha of 5% and power of 90%) in favour of the patients with primary anastomosis. More than 35 hospitals will participate in this study with an estimated total inclusion of 100 patients per year. Patients will be followed for one year. The study will be executed in concordance with the protocol, the Good Clinical Practice guidelines and regulatory requirements. After closure of the LOLA-arm due to safety concerns for laparoscopic lavage, the protocol and sample size has for the DIVA-arm been adjusted to 118 patients per study arm (faecal or purulent peritonitis).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Perforated Diverticulitis
Keywords
diverticulitis, perforation, sigmoidectomy, sigmoid resection, lavage, laparoscopic, wash-out, rinsing, hartmann, end-colostomy, primary anastomosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
283 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Purulent peritonitis
Arm Type
Experimental
Arm Description
Patients with purulent peritonitis are randomised at a 2:1:1 ratio between Laparoscopic lavage and drainage Sigmoidectomy with primary anastomosis Sigmoidectomy with end-colostomy
Arm Title
Fecal peritonitis or overt perforation
Arm Type
Experimental
Arm Description
Patients with fecal peritonitis or an overt perforation are randomised between Sigmoidectomy with primary anastomosis Sigmoidectomy with end-colostomy
Intervention Type
Procedure
Intervention Name(s)
Laparoscopic lavage and drainage
Intervention Description
[CLOSED] The abdominal cavity is irrigated with six litres of warm saline in all four quadrants. At the end of the procedure a Douglas drain is inserted via the right lateral port. ***This part of the study was closed in 2013 on advice of the data and safety monitoring board due to safety issues
Intervention Type
Procedure
Intervention Name(s)
Sigmoidectomy with primary anastomosis
Other Intervention Name(s)
Sigmoid resection
Intervention Description
[OPEN] Sigmoidectomy is done according to the guidelines of the American Society of Colon and Rectal Surgeons. The distal transsection margin has to be on the proximal rectum, the proximal margin is determined by the absence of wall thickening due to diverticulitis. The type of anastomosis is done according to the preference of the operating surgeon. A loop ileostomy can be fashioned in order to ensure faecal deviation to the discretion of the surgeon.
Intervention Type
Procedure
Intervention Name(s)
Sigmoidectomy with end-colostomy
Other Intervention Name(s)
Hartmann procedure
Intervention Description
[OPEN] This is a two-stage procedure with the intention to close the colostomy in a second stage. During the primary surgery, only the perforated diseased part must be resected. There is no need of having the distal transsection line on the proximal rectum.
Primary Outcome Measure Information:
Title
Mortality and major morbidity (combined)
Description
The primary outcome in the lavage vs. resectional intervention comparison (LOLA), will be poor clinical outcome, defined as a combined endpoint consisting of mortality and major morbidity one year after initial surgery. Major morbidity includes any of the following events or conditions: reintervention, wound dehiscence, incisional hernia, abscess needing percutaneous drainage, urosepsis, myocardial infarction, renal failure and respiratory insufficiency.
Time Frame
One-year
Title
Stoma-free survival
Description
Stoma-free survival one year after initial surgery, is the primary outcome for the comparison of the resectional strategies (DIVA).
Time Frame
One year
Secondary Outcome Measure Information:
Title
Operating time
Time Frame
- (day 1)
Title
Hospital stay
Time Frame
- (day one until discharge from hospital)
Title
Number of days alive and outside the hospital
Time Frame
One year
Title
Incisional hernia
Time Frame
One year
Title
Reinterventions
Description
All reinterventions within a one year time frame, including percutaneous abscess drainage.
Time Frame
One year
Title
Health related quality of life
Description
SF-36, EQ-5D, GIQLI measured at 2, 4, 13 and 26 weeks after primary surgery.
Time Frame
One year
Title
Health care utilisation and associated costs
Description
SF-HLQ measured at 4, 13, 26, 39 and 52 weeks after primary surgery
Time Frame
One year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: patients suspected of diverticulitis age in between 18 and 85 years old with written informed consent with free air on plain abdominal or thoracic X-ray or CT-scan OR with peritonitis and diffuse gas or fluid on CT-scan Exclusion Criteria: dementia prior sigmoidectomy steroid treatment > 20 mg daily prior pelvic irradiation preoperative shock: requirement of inotropics due to circulatory insufficiency
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
W.A. Bemelman, Professor
Email
w.a.bemelman@amc.uva.nl
First Name & Middle Initial & Last Name or Official Title & Degree
J.F. Lange, Professor
Email
j.f.lange@erasmusmc.nl
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
J.F. Lange, Professor
Organizational Affiliation
Erasmus Medical Centre, Rotterdam
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
W.A. Bemelman, Professor
Organizational Affiliation
Academic Medical Centre, Amsterdam
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Clinic St. Luc
City
Brussels
Country
Belgium
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
A. Kartheuser
First Name & Middle Initial & Last Name & Degree
C. Remue
Facility Name
University Hospital Leuven
City
Leuven
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
A. d'Hoore
Facility Name
Jeroen Bosch Hospital
City
's-Hertogenbosch
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
H. Prins
Facility Name
Flevo Hospital
City
Almere
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
M. Boom
Facility Name
Rijnland Hospital
City
Alphen aan de Rijn and Leiderdorp
Country
Netherlands
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
P.A. Neijenhuis
Facility Name
Meander Medical Centre
City
Amersfoort
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
E.C.J. Consten
Facility Name
Academic Medical Centre
City
Amsterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
W.A. Bemelman
Facility Name
Free University Medical Centre
City
Amsterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
D.L. van der Peet
Facility Name
Onze Lieve Vrouwe Hospital
City
Amsterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
M.F. Gerhards
Facility Name
Slotervaart Hospital
City
Amsterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
S.C. Bruin
Facility Name
St. Lucas Andreas Hospital
City
Amsterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
B.A. van Wagensveld
Facility Name
Alysis Medical Centre
City
Arnhem
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
C.F.J.M. Blanken-Peeters
Facility Name
Rode Kruis Hospital
City
Beverwijk
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
H.A. Cense
Facility Name
Amphia Hospital
City
Breda
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
R.M.P.M. Crolla
Facility Name
IJsselland Hospital
City
Capelle aan de IJssel
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
E.J.R. de Graaf
Facility Name
Reinier de Graaf Hospital
City
Delft
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
T.M. Karsten
Facility Name
Deventer Hospital
City
Deventer
Country
Netherlands
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
R.J.I. Bosker
Facility Name
Albert Schweitzer Hospital
City
Dordrecht and Zwijndrecht
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
J.A.B. van der Hoeven
Facility Name
Gelderse Vallei Hospital
City
Ede
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ph.M. Kruyt
Facility Name
Catharina Hospital
City
Eindhoven
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
S.W. Nienhuijs
Facility Name
Medical Spectrum Twente
City
Enschede
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
E.B. van Duyn
Facility Name
Groene Hart Hospital
City
Gouda
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
D.J. Swank
Facility Name
Kennemer Hospital
City
Haarlem
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
H.B.A.C. Stockmann
Facility Name
Atrium Medical Centre
City
Heerlen and Brunssum
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
M.N. Sosef
Facility Name
Tergooi Hospitals
City
Hilversum and Blaricum
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
A.A.W. van Geloven
Facility Name
Spaarne Hospital
City
Hoofddorp
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Q.A.J. Eijsbouts
Facility Name
Westfries Hospital
City
Hoorn
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
M.J.P.M. Govaert
Facility Name
Leiden University Medical Centre
City
Leiden
Country
Netherlands
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
R.A.E.M. Tollenaar
Facility Name
Maastricht University Medical Centre
City
Maastricht
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
L.P.S. Stassen
Facility Name
St. Antonius Hospital
City
Nieuwegein
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
M.J. Wiezer
Facility Name
Erasmus Medical Centre
City
Rotterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
J.F. Lange
Facility Name
Ikazia Hospital
City
Rotterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
W.F. Weidema
Facility Name
Maasstad Hospital
City
Rotterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
P.P.L.O. Coene
Facility Name
St. Franciscus Hospital
City
Rotterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
G.H.H. Mannaerts
Facility Name
Orbis Medical Centre
City
Sittard
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
A.G.M. Hoofwijk
Facility Name
Haga Hospital
City
The Hague
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
W.H. Steup
Facility Name
Twee Steden Hospital
City
Tilburg and Waalwijk
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
J.K. Maring
Facility Name
University Medical Centre Utrecht
City
Utrecht
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
W.M.U. van Grevenstein
Facility Name
Máxima Medical Centre
City
Veldhoven
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
G.D. Slooter
Facility Name
Zaans Medical Centre
City
Zaandam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
A.F. Engel
Facility Name
Isala Hospitals
City
Zwolle
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
E.G.J.M. Pierik

12. IPD Sharing Statement

Citations:
PubMed Identifier
19788490
Citation
Toorenvliet BR, Swank H, Schoones JW, Hamming JF, Bemelman WA. Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a systematic review. Colorectal Dis. 2010 Sep;12(9):862-7. doi: 10.1111/j.1463-1318.2009.02052.x. Epub 2009 Sep 26.
Results Reference
background
PubMed Identifier
15622591
Citation
Salem L, Flum DR. Primary anastomosis or Hartmann's procedure for patients with diverticular peritonitis? A systematic review. Dis Colon Rectum. 2004 Nov;47(11):1953-64. doi: 10.1007/s10350-004-0701-1.
Results Reference
background
PubMed Identifier
16752192
Citation
Constantinides VA, Tekkis PP, Athanasiou T, Aziz O, Purkayastha S, Remzi FH, Fazio VW, Aydin N, Darzi A, Senapati A. Primary resection with anastomosis vs. Hartmann's procedure in nonelective surgery for acute colonic diverticulitis: a systematic review. Dis Colon Rectum. 2006 Jul;49(7):966-81. doi: 10.1007/s10350-006-0547-9.
Results Reference
background
PubMed Identifier
35606544
Citation
Hoek VT, Edomskis PP, Stark PW, Lambrichts DPV, Draaisma WA, Consten ECJ, Lange JF, Bemelman WA; LADIES trial collaborators. Laparoscopic peritoneal lavage versus sigmoidectomy for perforated diverticulitis with purulent peritonitis: three-year follow-up of the randomised LOLA trial. Surg Endosc. 2022 Oct;36(10):7764-7774. doi: 10.1007/s00464-022-09326-3. Epub 2022 May 23.
Results Reference
derived
PubMed Identifier
31178342
Citation
Lambrichts DPV, Vennix S, Musters GD, Mulder IM, Swank HA, Hoofwijk AGM, Belgers EHJ, Stockmann HBAC, Eijsbouts QAJ, Gerhards MF, van Wagensveld BA, van Geloven AAW, Crolla RMPH, Nienhuijs SW, Govaert MJPM, di Saverio S, D'Hoore AJL, Consten ECJ, van Grevenstein WMU, Pierik REGJM, Kruyt PM, van der Hoeven JAB, Steup WH, Catena F, Konsten JLM, Vermeulen J, van Dieren S, Bemelman WA, Lange JF; LADIES trial collaborators. Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superiority trial. Lancet Gastroenterol Hepatol. 2019 Aug;4(8):599-610. doi: 10.1016/S2468-1253(19)30174-8. Epub 2019 Jun 6.
Results Reference
derived
PubMed Identifier
26209030
Citation
Vennix S, Musters GD, Mulder IM, Swank HA, Consten EC, Belgers EH, van Geloven AA, Gerhards MF, Govaert MJ, van Grevenstein WM, Hoofwijk AG, Kruyt PM, Nienhuijs SW, Boermeester MA, Vermeulen J, van Dieren S, Lange JF, Bemelman WA; Ladies trial colloborators. Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial. Lancet. 2015 Sep 26;386(10000):1269-1277. doi: 10.1016/S0140-6736(15)61168-0. Epub 2015 Jul 22. Erratum In: Lancet. 2019 Jun 1;393(10187):2200.
Results Reference
derived
Links:
URL
http://www.diverticulitis.nl
Description
Related Info

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Laparoscopic Peritoneal Lavage or Resection for Generalised Peritonitis for Perforated Diverticulitis

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