Open versus closed diagnostic peritoneal lavage: a comparison on safety, rapidity, efficacy

The diagnostic utility of peritoneal lavage remains a topic of ongoing discussion among surgeons. While open and closed techniques are both employed, the relative merits of each are not fully resolved. Prior research has shown that both methods can detect intra-abdominal bleeding with high accuracy. However, no prior work had resolved the differences in procedural speed or failure rates between the two approaches. This gap motivated a study comparing the two techniques in a clinical setting. The debate hinges on whether one method is safer or more efficient than the other. Both methods are commonly taught in surgical training, but their comparative advantages are not well established. The lack of clear evidence on failure rates and procedural time has limited clinical decision-making. This study aims to clarify these uncertainties in a real-world patient population.

The purpose of the study was to compare open and closed diagnostic peritoneal lavage (DPL) in terms of diagnostic accuracy and procedural efficiency. The specific problem addressed is the lack of consensus on which method is more reliable and faster in clinical practice. The motivation stems from the need to guide surgical training and patient care decisions. By analyzing a large patient cohort, the study sought to provide evidence-based insights into the two techniques. The goal was to determine if one method offers advantages in speed or reliability. The study also aimed to assess the incidence of procedural failure in both groups. This information could help surgeons choose the most appropriate technique in different clinical scenarios. The findings may influence how DPL is taught and implemented in trauma centers.

The study involved 130 patients who underwent diagnostic peritoneal lavage (DPL). Participants were divided into two groups: 55 received closed DPL and 75 received open DPL. Sensitivity and specificity were calculated for each group. The time required for catheter insertion and fluid infusion was recorded for all patients. The number of prolonged procedures was also tracked. No intra-abdominal or wound complications were reported in either group. The study focused on comparing procedural efficiency and failure rates. Statistical analysis was used to evaluate differences between the two groups. The study design allowed for a direct comparison of clinical outcomes.

Closed DPL demonstrated 100% sensitivity and 96.6% specificity, while open DPL had 92.2% sensitivity and 100% specificity. The mean time for catheter insertion and fluid infusion was significantly shorter in the closed DPL group. The closed method also had fewer prolonged procedures. No intra-abdominal or wound complications were observed in either group. However, 10 DPL procedures failed to produce a definite result. Eight of these failures (10.6%) occurred in the open DPL group. Two failures (3.6%) were in the closed DPL group (P < 0.05). These findings suggest closed DPL is more expeditious and less likely to produce inconclusive results.

The authors propose that closed DPL is as sensitive and specific as open DPL but is more expeditious. Both methods are equally safe in terms of complications. The closed method appears to reduce the likelihood of inconclusive results. The study supports the continued use of both techniques in clinical practice. The findings suggest that closed DPL may be preferable in settings where speed is critical. The authors emphasize that both procedures should remain part of surgical training. No essential differences in diagnostic accuracy were found between the two methods. The results highlight the importance of procedural efficiency in trauma care.