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To Irrigate or Not to Irrigate the Abdominal Cavity

John L. Hunt, MD

Arch Surg. 1982;117(2):209-212.

Abstract
• The objectives of surgery for generalized peritonitis are to eliminate the source of continual bacterial contamination and to prevent septicemia and intra-abdominal abscess formation. A prospective randomized study of three different operative approaches of treating residual peritoneal contamination was undertaken: group 1, no peritoneal irrigation (14 patients); group 2, intraoperative peritoneal irrigation only (15 patients); group 3, both intraoperative and postoperative peritoneal irrigation (15 patients). The mortality in groups 1, 2, and 3 was 28.5%, 26.6%, and 33%, respectively. The overall incidence of septicemia and intra-abdominal abscesses in groups 1, 2, and 3 was 23%, 22%, and 17%, respectively. In those patients who survived, the incidence of intra-abdominal abscesses, wound infection, and septicemia was 6%, 23%, and 13%, respectively. In this series, there was no detectable difference in the mortality and infectious complications between the three treatment groups. The only clinical factors that adversely affected mortality and morbidity were peritonitis originating from the colon and age greater than 60 years. Early surgical intervention with removal of the source of peritonitis, debridement of all necrotic tissue, and drainage of abscesses remain the cornerstones of successful therapy in generalized peritonitis.

(Arch Surg 1982;117:209-212)

Author Affiliations
From the Department of Surgery, University of Texas Health Science Center, Dallas.

Footnotes
Accepted for publication Oct 5, 1981.

Read at the first annual meeting of the Surgical Infection Society, Chicago, April 25, 1981.

Reprint requests to Department of Surgery, University of Texas Health Science Center, 5323 Harry Hines Blvd, Dallas, TX 75235 (Dr Hunt).

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