Association between intraoperative irrigation volume and postoperative abdominal abscess in perforated peptic ulcer

Perforated peptic ulcer is a critical emergency disease requiring surgery, and postoperative intra-abdominal abscess (IAA), an organ/space surgical site infection (SSI), is a common complication. Intraoperative irrigation is a common IAA prevention approach; however, scientific evidence supporting its effectiveness is lacking. We aimed to investigate the association between intraoperative irrigation volume and IAA using multicentre data.

This multicentre retrospective cohort study was conducted between January 2011 and December 2023. The study included patients aged ≥ 18 years who underwent laparotomy or laparoscopy for perforated peptic ulcer, defined as perforation of a gastric or duodenal ulcer. The primary and secondary outcomes were IAA incidence and superficial incisional SSI, respectively, and their association with the intraoperative irrigation volume was determined through multivariable logistic regression analyses.

The study included 478 patients with a median age of 66 years (interquartile range [IQR]: 54-75 years), 344 (72.0%) of whom were males. The median irrigation volume was 7.0 (IQR: 5-10) L. Among the 478 patients, IAA and superficial incisional SSI occurred in 52 (10.9%) and 71 (14.9%), respectively. The irrigation volume and the outcomes exhibited no significant association (for IAA: adjusted odds ratio [AOR] = 1.04, 95% confidence interval [CI] = 0.97-1.11, p = 0.25; for superficial incisional SSI: AOR = 1.07, 95% CI = 1.00-1.14, p = 0.053).

There was no statistically significant association between increased intraoperative irrigation volume and a decreased incidence of postoperative IAA formation. These findings suggest that alternative strategies, rather than uncontrolled high-volume irrigation, are required for IAA prevention.