Intra-operative peritoneal lavage – who does it and why?

Abstract

INTRODUCTION Intra-operative peritoneal lavage (IOPL) is widely practised but its benefits are unclear. The frequency and pattern of its use amongst general surgeons is investigated.METHODS A postal questionnaire was sent to 153 general surgical consultants and registrars enquiring about their use of IOPL. The surgeon was asked the volume and type of lavage fluid used, under various circumstances.RESULTS 118 (77%) questionnaires were returned. 115 (97%) surgeons used IOPL. The majority of surgeons (61%) lavaged until the fluid was clear, 20% used more than 1 l and 17% used between 500-1000 ml. In the case of the dirty abdomen (i.e. gross pus or faecal peritonitis), 47% used saline as the lavage fluid, 38% aqueous betadine, 9% water and 3% antibiotic lavage. Similar results were found in the case of a contaminated abdomen (i.e. a breached hollow viscus). 34% of surgeons used IOPL during clean cases. 36% used water lavage during intra-abdominal cancer surgery; 21% lavaged with saline and 17% with betadine. More registrars (47%) than consultants (29%) lavaged with water during cancer surgery. Consultants, however, used more aqueous betadine.CONCLUSIONS The frequency of use and choice of lavage fluid varies widely. The successful management of the septic abdomen rests on at least 3 tenants -systemic antibiotics, control of the source of infection and aspiration of gross contaminants. There is little good evidence in the literature to support IOPL in the management of the septic abdomen. The use of IOPL during cancer surgery is supported by in vitro evidence. The current use of IOPL, as shown by this study, appears not to be evidence based.

Histological features of peritoneal lavage with ropivacaine in rats with fecal peritonitis

“…Despite the controversy surrounding the efficacy of peritoneal lavage in the medical literature 17,18 , our present experiment has shown that peritoneal lavage does lower mortality. The local anesthetics increase survival in several studies on experimental models with mice 19 and dogs 20 even when administered systemically.…”

Effects of peritoneal lavage with lidocaine on survival of rats with fecal peritonitis

“…Nevertheless, it is known that peritoneal washing in peritonitis is a controversial issue. although peritoneal washing is utilized by a large number of surgeons 23 . Peritoneal washing with physiological saline of peritonitic rats, evoked lower mortality compared to plain cleaning of the cavity with compresses 24 .…”

Extensive peritoneal lavage decreases postoperative C-reactive protein concentrations: a RCT

“…Although lavage during laparoscopy is more efficient than during laparotomy [3], its usefulness remains controversial [4][5][6][7]. Over the last years, extensive peritoneal lavage during laparoscopy was reported to be useful for the treatment of complications following colorectal surgery and for diverticulitis [8][9][10][11][12][13][14][15][16].…”