Antiseptic wound irrigation to prevent surgical site infection after laparotomy: meta-analysis

Surgical site infection after laparotomy is a major postoperative complication. The efficacy of prophylactic laparotomy wound irrigation to reduce surgical site infection rates remains controversial. This study evaluates the impact of antiseptic wound irrigation on surgical site infection prevention.

A systematic review and meta-analysis, following PRISMA 2020, included randomized clinical trials and observational studies (published after 1999) comparing antiseptic or saline irrigation versus saline or no irrigation before laparotomy closure in adult patients with surgical site infection as the primary outcome. Databases searched included MEDLINE, EMBASE, Cochrane Library, and Google Scholar (September 2024). Risk of bias was assessed using RoB 2 and ROBINS-I; Grading of Recommendations Assessment, Development, and Evaluation evaluated evidence certainty.

Eighteen studies (6368 patients) reported an overall surgical site infection rate of 14.7%. Thirteen studies compared antiseptic with saline irrigation, showing no significant effect (relative risk 0.80, 95% confidence interval 0.58 to 1.09; P = 0.159) with very low evidence certainty. Excluding laparoscopic cases and high-risk bias studies revealed a favourable effect for antiseptic irrigation (relative risk 0.75, 0.64 to 0.87; P < 0.001) with moderate certainty. Three studies compared antiseptic with no irrigation, and four compared saline with no irrigation. Meta-analysis indicated reduced surgical site infection rates with any irrigation (antiseptic or saline) versus no irrigation (relative risk 0.52, 0.37 to 0.74; P < 0.001) with moderate certainty.

Wound irrigation (antiseptic or saline) likely reduces surgical site infection rates after laparotomy. Evidence comparing antiseptic versus saline is uncertain but suggests a potential benefit after excluding the high risk of bias studies. Further high-quality, standardized trials are needed.