Prophylactic saline peritoneal lavage in elective colorectal operations

Area of Science:

• Surgical Oncology
• Infectious Disease Prevention
• Gastrointestinal Surgery

Background:

• Colorectal cancer surgery carries a risk of postoperative infection.
• Prophylactic antimicrobials are commonly used but may contribute to resistance.
• Intra-abdominal bacterial contamination is a key factor in surgical site infections.

Purpose of the Study:

• To evaluate the efficacy of intraoperative saline peritoneal lavage in reducing bacterial counts.
• To determine if bacterial count reduction by lavage can eliminate the need for prophylactic antimicrobials.
• To assess the impact of saline lavage on postoperative infection rates in colorectal cancer patients.

Main Methods:

• A single intraoperative five-liter saline peritoneal lavage was performed.
• Bacterial counts (aerobic and anaerobic) in peritoneal fluid were measured before and after lavage.
• Postoperative infection rates (wound infection, intra-abdominal abscess, septicemia) were monitored in 21 patients.

Main Results:

• Saline lavage significantly reduced aerobic bacteria from 2 x 10(4) to 5 x 10(1) (P < 0.001).
• Anaerobic bacteria counts decreased significantly from 8 x 10(4) to 1 x 10(2) (P < 0.001).
• Despite bacterial reduction, high rates of postoperative sepsis occurred: wound infection (47%), intra-abdominal abscess (26%), septicemia (13%).

Conclusions:

• Intraoperative saline peritoneal lavage effectively reduces bacterial load in the peritoneal cavity during colorectal cancer surgery.
• Saline lavage alone is not sufficient to prevent high rates of postoperative sepsis.
• Short-term antimicrobial prophylaxis remains crucial for managing infection risk in these patients.