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Peritoneal lavage in abdominal sepsis. A controlled clinical study
M Schein1, G Gecelter, W Freinkel
1Department of Surgery, J. G. Strijdom Hospital, Johannesburgh, South Africa.
Archives of Surgery (Chicago, Ill. : 1960)
|September 1, 1990
Summary
Intraoperative peritoneal lavage (IOPL) using saline or antibiotics did not significantly alter outcomes for patients with peritonitis undergoing emergency laparotomy. The study found no significant difference in mortality, hospital stay, or complication rates between groups.
Area of Science:
- Surgical Gastroenterology
- Critical Care Medicine
- Infectious Diseases
Background:
- Peritoneal contamination during emergency laparotomies for peritonitis presents a significant clinical challenge.
- The efficacy of intraoperative peritoneal lavage (IOPL) as an adjunct treatment remains a subject of ongoing debate.
- Standard treatment protocols often involve lavage, but optimal solutions and their impact on patient outcomes are not well-defined.
Purpose of the Study:
- To prospectively evaluate the impact of intraoperative peritoneal lavage (IOPL) with saline, with or without antibiotics, on patient outcomes following emergency laparotomies for peritonitis.
- To determine if IOPL influences key clinical markers such as mortality, hospital stay, wound infections, and surgical/medical complications.
- To provide evidence-based insights into the controversial role of IOPL in managing peritoneal contamination.
Main Methods:
- A prospective randomized trial involving 87 patients with peritonitis undergoing emergency laparotomies.
- Patients were allocated to three groups: no IOPL, IOPL with saline, or IOPL with saline and chloramphenicol succinate.
- Outcomes including mortality, hospital stay, wound infections, surgical complications, and medical complications were compared across groups, with adjustments for APACHE II scores.
Main Results:
- No statistically significant differences in mortality rates were observed between the three groups (21%, 21%, and 10%).
- Hospital stay (13, 13, and 10 days) and the incidence of wound infections (20%, 17%, and 17%) also showed no significant variations.
- While surgical and medical complication rates differed, these were not statistically significant across the groups, and outcomes correlated with preoperative APACHE II scores.
Conclusions:
- Intraoperative peritoneal lavage (IOPL) with either saline solution or saline with antibiotics does not appear to significantly improve outcomes in patients undergoing emergency laparotomies for peritonitis.
- The study suggests that IOPL may not be a critical factor in altering the course of peritonitis following emergency surgery.
- Clinical outcomes are more closely associated with the severity of illness, as indicated by the APACHE II scores, rather than the use of IOPL.