Meta-analysis of the effect of peritoneal lavage on survival in experimental peritonitis

Irrigation of peritoneal cavity with cold atmospheric plasma treated solution effectively reduces microbial load in rat acute peritonitis model

Accurate and timely diagnosis of appendicitis in children can be challenging, which leads to delayed admittance or misdiagnosis that may cause perforation. Surgical management involves the elimination of the focus (appendectomy) and the reduction of the contamination with peritoneal irrigation to prevent sepsis. However, the validity of conventional irrigation methods is being debated, and novel methods are needed. In the present study, the use of cold plasma treated saline solution as an intraperitoneal irrigation solution for the management of acute peritonitis was investigated. Chemical and in vitro microbiological assessments of the plasma-treated solution were performed to determine the appropriate plasma treatment time to be used in in-vivo experiments. To induce acute peritonitis in rats, the cecal ligation and perforation (CLP) model was used. Sixty rats were divided into six groups, namely, sham operation, plasma irrigation, CLP, dry cleaning after CLP, saline irrigation after CLP, and plasma-treated saline irrigation after CLP group. The total antioxidant and oxidant status, oxidative stress index, microbiological, and pathological evaluations were performed. Findings indicated that plasma-treated saline contains reactive species, and irrigation with plasma-treated saline can effectively inactivate intraperitoneal contamination and prevent sepsis with no short-term local and/or systemic toxicity.

Novel Antibiotic-Irrigating Wound Protector Reduces Infectious Complications in Robot-Assisted Radical Cystectomy with Extracorporeal Urinary Diversion

OBJECTIVE

To determine whether use of an antibiotic-irrigating wound protector (AWP) reduces infectious complications after robotic radical cystectomy with extracorporeal urinary diversion (RCUD).

METHODS

A prospectively maintained bladder cancer database was queried for patients undergoing robotic RCUD at a tertiary referral center one year prior to implementing an AWP and one year after (2018-2020). All diversions were performed extra-corporally. 92 patients total. 46 consecutive patients using a traditional wound protector (TWP) and 46 consecutive with an AWP. Infections were classified as symptomatic urinary tract infection, blood stream infection, and surgical site infection. The incidence of infectious complications at 30- and 90-days were compared.

RESULTS

Baseline patient characteristics between the 2 groups showed no statistically significant differences. The overall complication rate was 65.2% in the TWP group and 26.1% in the AWP group at 30-days, and 67.4% vs 30.4% at 90-days. Focusing on infections, the 30-day complication rate was 30.4% in the TWP group compared to 6.5% in the AWP group (P =.003). This pattern persisted at 90-days with 37.0% in the TWP group compared to 6.5% in the AWP group (P =.004). Most complications were symptomatic UTI and blood stream infections, 14/24 (58%), requiring parenteral antibiotic treatment.

CONCLUSION

We provide preliminary data showing use of an AWP can reduce infectious complications after RCUD. While larger prospective studies are warranted, our findings are a significant step towards decreasing morbidity of an already highly morbid procedure.

A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift

OBJECTIVE

To determine the optimal volume of abdominal irrigation that will prevent surgical site infections (both deep and superficial), eviscerations and fistula formations; and improve 30-day mortality in trauma patients.

METHODS

We conducted a three-arm parallel clinical superiority randomized controlled trial comparing different volumes of effluent (5, 10 and 20 liters) used in trauma patients (both blunt and penetrating) age 14 and above undergoing an emergency laparotomy between April 2002 and July 2004 in a busy urban Level 1 trauma center.

RESULTS

After randomization, a total of 204 patients were analyzed. All patient groups were comparable with respect to age, gender distribution, admission injury severity score, and mechanism of injury, estimated blood loss and degree of contamination. The mortality rate overall was 1.96% (4/204).No differences were noted with respect to contamination, wound infection, fistula formation, and evisceration. The twenty liter group (Group III) showed a trend toward an increased incidence of deep surgical site infections when compared to the five liter (Group I) (p=0.051) and ten liter (Group II) (p=0.057) groups. This did not however reach statistical significance.

CONCLUSION

The old surgical adage "the solution to pollution is dilution" is not applicable to trauma patients. Our results suggest that using more irrigation, even when large amounts of contamination have occurred, does not reduce post-operative complications or affect mortality; and it may predispose patients to increased incidence of abscess formation. (Trial registration number: ISRCTN66454589).

Effect of the application of a bundle of three measures (intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples) on the surgical site infection after elective laparoscopic colorectal cancer surgery

BACKGROUND

Surgical site infection (SSI) prevention bundles include the simultaneous use of different measures, which individually have demonstrated an effect on prevention of SSI. The implementation of bundles can yield superior results to the implementation of individual measures. The aim of this study was to address the effect of the application of a bundle including intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples, on the surgical site infection after elective laparoscopic colorectal cancer surgery.

METHODS

A prospective, randomized study was performed, including patients with diagnosis of colorectal neoplasms and plans to undergo an elective laparoscopic surgery. The patients were randomized into two groups: those patients following standard bundles (Group 1) and those ones following the experimental bundle with three additional measures, added to the standard bundle. Incisional and organ space SSI were investigated. The study was assessor-blinded.

RESULTS

A total of 198 patients were included in the study, 99 in each group. The incisional SSI rate was 16% in Group 1 and 2% in Group 2 [p = 0.007; RR = 5.6; CI 95% (1.4-17.8)]. The organ-space SSI rate was 4% in Group 1 and 0% in Group 2 [p = 0.039; RR = 1.7; CI 95% (1.1-11.6)]. Median hospital stay was 5.5 days in Group 1 and 4 days in Group 2 (p = 0.028).

CONCLUSIONS

The addition of intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples, to a standard bundle of SSI prevention, reduces the incisional and organ-space SSI and consequently the hospital stay, after elective laparoscopic colorectal cancer surgery (ClinicalTrials.gov Identifier: NCT03081962).

Animal model of continuous peritoneal lavage with vacuum peritoneostomy

Purpose:

To establish and evaluate the feasibility of continuous peritoneal lavage with vacuum peritoneostomy in an animal model.

Methods:

Eight pigs aged 3-4 months, females, were anesthetized and submitted to laparotomy and installation of a continuous peritoneal lavage with vacuum peritoneostomy. The sta-bility of the system, the physiological effects of washing with NaCl 0.9% and the sys-tem clearance were evaluated.

Results:

Stability of vacuum peritoneostomy was observed, with no catheter leaks or obstructions and the clearance proved adequate, however, the mean volume of fluids aspirated by the peritoneostomy at the end of the experiment was higher than the volume infused by the catheters (p=0.02). Besides that, the animals presented a progressive increase in heart rate (p=0.04) and serum potassium (p=0.02).

Conclusion:

The continuous peritoneal lavage technique with vacuum peritoneostomy is feasible and presents adequate clearance.

Laparoscopic Lavage in the Management of Perforated Diverticulitis: a Contemporary Meta-analysis

IMPORTANCE

Perforated diverticulitis carries the risk of significant comorbidity and mortality. Although colon resection provides adequate source control, the procedure itself carries morbidity, as well as later stoma reversal procedures. The effectiveness of laparoscopic lavage to treat perforated diverticulitis remains unclear.

OBJECTIVE

We aimed to conduct a meta-analysis to evaluate current studies comparing laparoscopic lavage with colon resection in cases of perforated diverticulitis for the effectiveness in source control, without the need for subsequent interventions, stoma formation, and death.

DATA SOURCES

Electronic database searches were conducted using EMBASE, Pubmed, CINAHL, Cochrane databases, and clinicaltrials.gov following PRISMA guidelines.

STUDY SELECTION

Randomized controlled trials (RCTs) were included that compared laparoscopic lavage against colon resection for perforated diverticulitis.

DATA EXTRACTION AND SYNTHESIS

Risk of bias in RCT's was assessed the Cochrane Assessment of Bias risk tool and Jadad scale. A meta-analysis was performed using random-effects risk ratios (RR) and 95% confidence intervals (CI).

MAIN OUTCOME

Outcome measures included the total rate of reoperation, rate of reoperation for infection, need for subsequent percutaneous drainage, stoma formation, and mortality rate within 90 days.

RESULTS

Three eligible randomized controlled studies were identified, with a combined total of 372 patients. Laparoscopic lavage carried an increased rate of total reoperations (RR 2.07; CI 1.12-3.84; p = 0.021) and an increased rate of reoperation for infection (RR 5.56; CI 1.97-15.69; p = 0.001) compared with colon resection. In addition, laparoscopic lavage increased the rate of subsequent percutaneous drainage (RR 6.54; CI 1.77-24.16; p = 0.005) compared with colon resection, but a lesser risk of stoma formation within 90 days (RR 0.18; CI 0.12-0.27; p < 0.001). No difference in mortality rate was observed between treatments (RR 1.03; CI 0.45-2.34; p = 0.950).

CONCLUSION

Despite decreased rates of stoma formation and equivalent mortality rates as compared with colon resection, laparoscopic lavage for Hinchey III diverticulitis fails to completely control the source of infection. Our data show that laparoscopic lavage is associated with increased rates of total reoperations, increased rates of reoperation for infections, and need for subsequent percutaneous drainage.

Effect of Peritoneal Lavage with Clindamycin-Gentamicin Solution on Post-Operative Pain and Analytic Acute-Phase Reactants after Laparoscopic Sleeve Gastrectomy

BACKGROUND

Peritoneal lavage has been proposed to remove bacterial contamination and other materials promoting bacterial proliferation and pro-inflammatory cytokines that may enhance local inflammation. The aims of this study were to evaluate the effects of peritoneal lavage with physiologic saline or an antibiotic solution (clindamycin-gentamicin) on post-operative pain and analytic acute-phase reactants and to determine the microbiologic impact of both irrigations on peritoneal contamination in patients undergoing laparoscopic sleeve gastrectomy (LSG) as a bariatric procedure.

METHODS

The patients were randomized into two groups: Those undergoing an intra-abdominal lavage with physiologic saline (Group 1; n = 40) and those undergoing a similar lavage with a gentamicin-clindamycin solution (Group 2; n = 40). Peritoneal contamination, post-operative pain, and analytic acute-phase reactants 24 h after surgery were investigated.

RESULTS

The median pain score 24 h after surgery was 3.5 in Group 1 and 1.5 in Group 2 (p = 0.021). The glucose concentration (mean difference 33.1 mg/dL; p = 0.004), aspartate aminotransferase (AST) concentration (mean difference 41.8 U/L; p = 0.009), alanine aminotransferase (ALT) concentration (mean difference 34.2 U/L; p = 0.029), white blood cell count (mean difference 1930/mm(3); p = 0.029); C-reactive protein concentration (mean difference 27.3 mg/L; p = 0.036), and serum lactic acid concentration (mean difference 0.34 mg/L; p = 0.049) were significantly higher in Group 1. Peritoneal contamination also was significantly higher in Group 1 (17.5% vs 0; p = 0.006).

CONCLUSIONS

Intra-peritoneal irrigation with a gentamicin and clindamycin solution in patients undergoing LSG leads to a reduction in post-operative pain and peritoneal contamination, less alteration of acute-phase reactants, lower blood glucose concentration, a smaller increase in liver enzymes, and a shorter hospital stay.

Effect of Peritoneal Lavage with Clindamycin-Gentamicin Solution during Elective Colorectal Cancer Surgery on the Oncologic Outcome

BACKGROUND

Antibiotics combined with lavage have demonstrated a reduction in the bacterial contamination and decreases surgical site infection (SSI) rate. SSI leads to an immunocompromised situation, as immunologic defense is focused on controlling the septic focus, leaving unattended the neoplasm. It has been described that SSI may result in a worse oncologic outcome. The aim of this study is to evaluate prospectively the effect of peritoneal lavage with clindamycin and gentamicin on the oncologic outcome of colorectal tumors.

METHODS

A randomized study of patients with diagnosis of colorectal neoplasms and undergoing elective surgery was performed at our institutions between January and September 2011. Patients were randomly assigned into two groups: Those undergoing an intra-abdominal lavage with normal saline (Group 1) and those undergoing an intra-abdominal lavage with a gentamicin-clindamycin solution (Group 2). Recurrence, global survival, and disease-free survival were investigated.

RESULTS

One hundred and four patients were analyzed, with 52 in each group. After a minimum follow-up of 42 mo, mean disease-free survival was 37.2 ± 14.2 mo in Group 1 and 25.8 ± 16.3 mo in Group 2 (mean difference 11.4; confidence interval (CI) 95% (2.2-25.1); p = 0.009). Mean global survival was 44.2 ± 11.9 mo in Group 1 and 34.1 ± 14.1 mo in Group 2 (mean difference 10.1; CI 95% (2.2-18);p = 0.016).

CONCLUSION

The intra-peritoneal lavage with gentamicin and clindamycin increases the disease-free and global survival colorectal tumors.

Impact of bacterial contamination of the abdominal cavity during pancreaticoduodenectomy on surgical-site infection

Background

Several risk factors for complications after pancreaticoduodenectomy have been reported. However, the impact of intraoperative bacterial contamination on surgical outcome after pancreaticoduodenectomy has not been examined in depth.

Methods

This retrospective study included patients who underwent pancreaticoduodenectomy and peritoneal lavage using 7000 ml saline between July 2012 and May 2014. The lavage fluid was subjected to bacterial culture examination. The influence of a positive bacterial culture on surgical-site infection (SSI) and postoperative course was evaluated. Risk factors for positive bacterial cultures were also evaluated.

Results

Forty-six (21·1 per cent) of 218 enrolled patients had a positive bacterial culture of the lavage fluid. Incisional SSI developed in 26 (57 per cent) of these 46 patients and in 13 (7·6 per cent) of 172 patients with a negative lavage culture (P &lt; 0·001). Organ/space SSI developed in 32 patients with a positive lavage culture (70 per cent) and in 43 of those with a negative culture (25·0 per cent) (P &lt; 0·001). Grade B/C pancreatic fistula was observed in 22 (48 per cent) and 48 (27·9 per cent) respectively of patients with positive and negative lavage cultures (P = 0·010). Postoperative hospital stay was longer in patients with a positive lavage culture (28 days versus 21 days in patients with a negative culture; P = 0·028). Multivariable analysis revealed that internal biliary drainage, combined colectomy and a longer duration of surgery were significant risk factors for positive bacterial culture of the lavage fluid.

Conclusion

Intraoperative bacterial contamination has an adverse impact on the development of SSI and grade B/C pancreatic fistula following pancreaticoduodenectomy.

Effect of Curcumin in Experimental Peritonitis

Despite medical advancements, the inflammatory cascade and oxidative stress worsen the prognosis in most cases of peritonitis. Curcumin has emerged as a potential antioxidant and anti-inflammatory agent in few of the acute inflammatory and infective conditions. We examined the effect of intraperitoneal injection of curcumin in endotoxin-induced peritonitis in rats. The blood and peritoneal fluid samples were collected at 3 and 24 h following the induction of peritonitis. Animals were sacrificed at 24 h and the organs preserved. The histopathological report of lung, liver, and intestines in the curcumin-treated rats showed maintenance of tissue architecture to a large extent compared to the control group which showed massive congestion, hemorrhage, and necrosis. The blood and peritoneal fluid total count and differential neutrophil counts were significantly higher at 24 h of induction of peritonitis. Serum amyloid assay and lipid peroxidation were significantly lower, and myeloperoxidase assay was higher in the curcumin-treated group at the end of 24 h; thus, curcumin probably demonstrated a neutrophil-mediated immunopotentiation and anti-inflammatory action thereby protecting the animal from endotoxemia-induced multi-organ damage.

Surgical intervention after catheter removal in a case of refractory peritoneal dialysis-related peritonitis

Peritonitis is the most common infection in peritoneal dialysis (PD) and has been noted to be not only a cause of mortality but also the leading cause of technique failure in patients maintained on PD. Appropriate management of peritonitis to improve patient outcome has been the focus of clinical practice. We report a case of refractory PD-related peritonitis with surgical intervention intending to control ongoing peritoneal infection despite aggressive antibiotics and timely catheter removal. Exploratory laparotomy was performed in this case, and an encapsulated abscess in the peritoneal and pelvic cavity was obliterated. Adhesiolysis was done simultaneously. Continuous postoperative peritoneal lavage and drainage were implemented. Symptoms dramatically improved after operation, and indwelling tubes were removed several days later. Finally, the patient recovered and switched to permanent hemodialysis without intra-abdominal complications. Our case suggested that appropriate and timely surgical intervention in refractory peritonitis is necessary for saving lives in certain subgroups of patients. Clearly, well-designed studies with large samples are warranted to explore this issue in more detail.

Influence of the peritoneal lavage with bupivacaine on the survival and resistance of colonic anastomoses performed under fecal peritonitis in rats

PURPOSE

To evaluate the effects of peritoneal lavage with bupivacaine on survival and initial resistance of anastomosis on distal colon, performed under peritonitis or not.

METHODS

Forty rats, weighing from 300 to 350 g (321.29 ± 11.3 1g), were randomly divided in four groups and underwent laparotomy and anastomosis on the distal colon six hours after induction of peritonitis by intraperitoneal injection of autologous fecal material or not. Group 1: No peritonitis and lavage with 3 ml NS; Group 2: No peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS; Group 3: Peritonitis and lavage with 3 ml NS; Group 4: Peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS. Necropsies were performed on the animals that died and the time of death was recorded. Surviving animals were submitted to euthanasia on the fifth post-operative day and Total Energy of Rupture biomechanical test (TER) was applied.

RESULTS

Group 4 showed survival increase compared to Group 3, without statistical significance. Group 3 presented the smallest average TER, with statistical significance.

CONCLUSION

Peritonitis increased mortality and influenced negatively the resistance of colic anastomosis in rats. Peritoneal lavage with bupivacaine increased anastomotic resistance.

Irrigation of abdomen with imipenem solution decreases surgical site infections in patients with perforated appendicitis: a randomized clinical trial

Background:

Perforated appendicitis is one of the most common causes of acute abdomen requiring emergent surgery for immediate appendectomy and peritoneal cavity irrigation; however, the efficacy of irrigation with antibiotic solutions is controversial.

Objectives:

The aim of this study was to assess the efficacy of imipenem solution irrigation on post-operative surgical site infections (SSIs), hospital length of stay, and hospital costs. We hypothesized that there would be lower rate of SSIs, a shorter hospital stay, and lower hospital cost in patients with perforated appendicitis who received peritoneal cavity irrigation with imipenem solution in comparison to their counterparts who received irrigation with normal saline.

Patients and Methods:

In this randomized single-blind parallel-group clinical trial, we enrolled 90 patients with perforated appendicitis with 12-50 years of age and randomly allocated them into experimental group (n = 45) and control group (n = 45). The control group received peritoneal irrigation with normal saline (0.9%) and experimental group underwent peritoneal irrigation with imipenem solution (1 mg/mL). All surgical procedures were performed in Imam Reza Hospital of Kermanshah University of Medical Sciences. The study primary outcome was surgical site infections (including wound infection and abdominal abscess) and the secondary outcomes were length of hospital stay and hospital cost. Chi-squared and t-tests were used to analyze the study data.

Results:

Imipenem solution irrigation was associated with significant clinical improvement at one-month follow-up. The experimental group presented with significantly lower rate of SSIs and shorter length of hospital stay. The experimental group had lower rate of SSIs compared to the control group (4.4% vs. 22.2%, respectively) (p= 0.013). The duration of hospital stay was nearly one day longer in control group (5.84 ± 2.58 days) vs. experimental group (4.91 ± 1.29 days) (P = 0.034), and hospital costs were $50 lower in experimental group ($500 ± $292) vs. control group ($450 ± $170) (P = 0.281).

Conclusions:

The study findings revealed that peritoneal lavage with imipenem solution (1 mg/mL) decreases the rate of post-operative SSIs in patients with perforated appendicitis in comparison to patients irrigated with normal saline alone. These patients also had shorter hospital stay, and lower hospital costs.

Effect of peritoneal cavity lavage with 0.9% and 3.0% saline solution in the lung and spleen of gerbils with induced peritonitis

BACKGROUND

Peritoneal cavity lavage is used widely in the treatment of peritonitis. Nonetheless, some studies question its rationale and prove it to be deleterious to the mesothelium. The present study aims to determine whether 0.9% and 3.0% saline lavage of the peritoneal cavity have an effect on the early systemic inflammatory response, namely, in the lung injury and splenic cellularity of gerbils with induced peritonitis.

METHODS

Thirty-four male gerbils were divided into four groups: Control (n=9), submitted to laparotomy at time zero, re-laparotomy after 2 h, and sacrificed after a total of 6 h from start; untreated (n=8), submitted to peritonitis induction through cecal ligation and puncture (CLP) at time zero, re-laparotomy intended for drying of abdominal cavity and resection of the ischemic cecum after 2 h, and sacrifice after a total of 6 h from start; saline (n=8), submitted to peritonitis induction through CLP at time zero, re-laparotomy intended for warm 0.9% saline lavage of the abdominal cavity and resection of the ischemic cecum after 2 h, and sacrificed after a total of 6 h from start; and hypertonic (n=9), submitted to peritonitis induction through CLP at time zero, re-laparotomy intended for warm hypertonic saline (3.0%) lavage of the abdominal cavity and resection of the ischemic cecum after 2 h, and sacrificed after a total of 6 h from start. After sacrifice, we collected the left lung and the spleen for morphometric analysis.

RESULTS

In the both the saline and hypertonic groups, there was significant decrease in the mean nuclei count in the lungs, compared with the untreated group (p<0.01). There was no difference in terms of nuclei count in the spleen among groups (p>0.05).

CONCLUSIONS

The present study demonstrated that the peritoneal lavage with large volumes of warm 0.9% and 3.0% saline has a beneficial effect on the early systemic inflammatory response in infected animals, modulating and reducing the lung injury but having no effect on splenic cell count.

Advantages of abandoning abdominal cavity irrigation and drainage in operations performed on children with perforated appendicitis

PURPOSE

This study evaluates the effect of peritoneal irrigation and drainage on postoperative morbidity when used together for perforated appendicitis.

MATERIAL AND METHODS

This study was conducted on children undergoing open appendectomy for perforated appendicitis. Sixty-one children with perforated appendicitis operated on with irrigation and drainage between July 1998 and September 2001 (group DI) and 173 children with perforated appendicitis who underwent surgery without irrigation and drainage (group NDI) between October 2001 and November 2011 were retrospectively evaluated (a total of 234 patients). All patients were treated and followed up by the same pediatric surgeon using the same protocol. Both groups were compared in respect to postoperative complications, including wound infection, wound dehiscence, intraabdominal abscess, prolonged ileus, the presence of small bowel obstruction requiring surgery, operative time, and length of postoperative hospital stay.

RESULTS

Of the total 234 patients, 151 were male and 83 were female with a mean age of 8.9 ± 3.7 years (range, 1.5-15 years). The wound infection rates were 4.9% in group DI and 1.7% in group NDI (P = .184). Wound dehiscence was seen in 1.6% vs 0%, prolonged ileus in 8% vs 2.3%, intraabdominal abscess in 4.9% vs 1.7%, and small bowel obstruction requiring surgery in 1.6% vs 0.6% of the patients (P = .261, P = .054, P = .184, and P = .454, respectively). No statistically significant difference in postoperative infectious complications was found between both groups. The length of postoperative hospital stay was 9.9 ± 4.1 days in group DI vs 6.3 ± 2.4 days in group NDI (P < .001). The operation times were 39 ± 8 and 31 ± 11 minutes, respectively (P < .001).

CONCLUSION

This study demonstrates that peritoneal irrigation and drainage in children with perforated appendicitis is not required, and in fact, these procedures cause an increase in operative time.

Effect of peritoneal lavage with clindamycin-gentamicin solution on infections after elective colorectal cancer surgery

BACKGROUND

Colorectal surgery may lead to infections because despite meticulous aseptic measures, extravasation of microorganisms from the colon lumen is unavoidable.

STUDY DESIGN

A prospective, randomized study was performed between January 2010 and December 2010. Patient inclusion criteria were a diagnosis of colorectal neoplasms and plans to undergo an elective curative operation. Patients were divided into 2 groups: Group 1 (intra-abdominal irrigation with normal saline) and Group 2 (intraperitoneal irrigation with a solution of 240 mg gentamicin and 600 mg clindamycin). The occurrence of wound infections and intra-abdominal abscesses were investigated. After the anastomosis, a microbiologic sample of the peritoneal surface was obtained (sample 1). A second sample was collected after irrigation with normal saline (sample 2). Finally, the peritoneal cavity was irrigated with a gentamicin-clindamycin solution and a third sample was obtained (sample 3).

RESULTS

There were 103 patients analyzed: 51 in Group 1 and 52 in Group 2. There were no significant differences between the groups in age, sex, comorbidities, or type of colorectal surgery performed. Wound infection rates were 14% in Group 1 and 4% in Group 2 (p = 0.009; odds ratio [OR] 4.94; 95% CI 1.27 to 19.19). Intra-abdominal abscess rates were 6% in Group 1 and 0% in Group 2 (p = 0.014; OR 2.14; 95% CI 1.13 to 3.57). The culture of sample 1 was positive in 68% of the cases, sample 2 was positive in 59%, and sample 3 in 4%.

CONCLUSIONS

Antibiotic lavage of the peritoneum is associated with a lower incidence of intra-abdominal abscesses and wound infections.