Peritoneal lavage in abdominal sepsis. A controlled clinical study
M. Schein, G. Gecelter, W. Freinkel, H. Gerding and P. J. Becker
Department of Surgery, J. G. Strijdom Hospital, Johannesburgh, South Africa.
The value of intraoperative peritoneal lavage (IOPL) with saline solution,
with or without antibiotics, in the treatment of peritoneal contamination,
continues to be controversial. A prospective trial was carried out in 87
patients who underwent emergency laparotomies for peritonitis. They were
randomized to be treated in one of three ways: group 1 (mean acute
physiologic and chronic health evaluation [APACHE] II score, 8) received no
IOPL; group 2 (mean APACHE II score, 10) received IOPL with saline
solution; and group 3 (mean APACHE II score, 8) received IOPL with saline
solution and 2 g of chloramphenicol succinate. In groups 1, 2, and 3, the
mortality was 21%, 21%, and 10%, respectively (not significant), and
correlated well with the preoperative APACHE II scores. In groups 1, 2, and
3, the mean hospital stay was 13, 13, and 10 days, respectively (not
significant), and the incidence of wound infections was 20%, 17%, and 17%,
respectively; the incidence of surgical complications was 10%, 24% and 7%,
respectively (not significant), and of medical complications, 24%, 31%, and
17%, respectively. We concluded that IOPL with saline solution or
antibiotics did not influence the outcome following laparotomies for
peritonitis.
