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Intra-operative peritoneal lavage--who does it and why?

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Intra-operative peritoneal lavage (IOPL) is common practice, but its benefits remain unclear. This study reveals wide variations in IOPL use and fluid choice among surgeons, suggesting practices may not be evidence-based.

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Area of Science:

  • Surgical Practice
  • Gastrointestinal Surgery
  • Oncology

Background:

  • Intra-operative peritoneal lavage (IOPL) is a common surgical procedure.
  • The clinical benefits and evidence supporting IOPL are not well-established.
  • Investigating the current frequency and patterns of IOPL use among general surgeons is crucial.

Purpose of the Study:

  • To investigate the frequency and patterns of intra-operative peritoneal lavage (IOPL) use in general surgery.
  • To determine the types of lavage fluid and volumes used under different surgical conditions.
  • To assess whether current IOPL practices align with existing evidence.

Main Methods:

  • A postal questionnaire was distributed to 153 general surgical consultants and registrars.
  • The questionnaire collected data on the use of IOPL, including fluid type, volume, and circumstances of use.
  • Response rate was 77% (118 returned questionnaires).

Main Results:

  • 97% of responding surgeons utilize IOPL.
  • Lavage fluid choices varied significantly, especially in septic or contaminated abdomens (saline, betadine, water, antibiotics).
  • IOPL was used in 34% of clean cases, and specific fluid choices differed between registrars and consultants in cancer surgery.

Conclusions:

  • The application and fluid selection for IOPL demonstrate considerable heterogeneity among surgeons.
  • There is limited evidence supporting IOPL for septic abdomen management, contrasting with some in vitro evidence for cancer surgery.
  • Current IOPL practices appear to be largely non-evidence-based, highlighting a need for revised guidelines.