Wound Irrigation and Peritoneal Lavage with Antiseptic/antibiotic Solution Before Wound Closure During Gastrointestinal Surgery: a Systematic Review and Meta-analysis

Overview

Journal BMC Surg

Publisher Biomed Central

Date 2025 Jan 24

PMID 39849481

Authors

Motoi Uchino

Koji Tamura

Shinsuke Nomura

Seiichi Shinji

Keita Kouzu

Hiroji Shinkawa

Tomohiro Ishinuki

Toru Mizuguchi

Hiroki Ohge

Seiji Haji

Junzo Shimizu

Yasuhiko Mohri

Chizuru Yamashita

Yuichi Kitagawa

Katsunori Suzuki

Motomu Kobayash

Masahiro Kobayashi

Yuki Hanai

Hiroshi Nobuhara

Hiroki Imaoka

Masahiro Yoshida

Toshihiko Mayumi

Hiroki Ikeuchi

Affiliations

Soon will be listed here.

Abstract

Background: Surgical site infections (SSIs) can affect mortality, morbidity, and medical costs. Although it has recently been reported that washing with antiseptic/antibiotic solution can prevent SSI in clean surgery, the clinical impact in gastrointestinal surgery is still uncertain. Therefore, we performed a systematic review and meta-analysis to evaluate the efficacy of antiseptic/antibiotic solution during wound irrigation or peritoneal lavage in gastroenterological surgery.

Methods: The database search used PubMed, MEDLINE, and Cochrane Library. The following inclusion criteria were set for the systematic review. 1) Studies comparing with or without antiseptic/antibiotic irrigation/lavage during gastrointestinal surgery. 2) Studies that described surgical site infections and adverse events. 3) Studies conducted after 2000.

Results: A total of 8 randomized controlled studies (RCTs) and 3 observational studies were included in this meta-analysis. Three RCTs of wound irrigation with povidone iodine (PVI) solution revealed no significant difference between the PVI and control groups [RR 1.41, 95% CI (0.92 to 2.17): p = 0.69]. Three RCTs of peritoneal lavage with antibiotic solution showed no significant difference between the interventional group and control groups [RR 0.39, 95% CI (0.10 to 1.55): p = 0.18]. Regarding other antiseptic or antibiotic solutions, the number of studies and participants were too small for evaluation.

Conclusion: Wound irrigation and peritoneal lavage with antiseptic/antibiotic solution did not have enough efficacy for preventing SSI during gastroenterological surgery.

References

de Jonge S, Boldingh Q, Solomkin J, Allegranzi B, Egger M, Dellinger E . Systematic Review and Meta-Analysis of Randomized Controlled Trials Evaluating Prophylactic Intra-Operative Wound Irrigation for the Prevention of Surgical Site Infections. Surg Infect (Larchmt). 2017; 18(4):508-519. DOI: 10.1089/sur.2016.272. View

Carballo Cuello C, Fernandez-de Thomas R, De Jesus O, de Jesus Espinosa A, Pastrana E . Prevention of Surgical Site Infection in Lumbar Instrumented Fusion Using a Sterile Povidone-Iodine Solution. World Neurosurg. 2021; 151:e700-e706. DOI: 10.1016/j.wneu.2021.04.094. View

McGowan J, Sampson M, Salzwedel D, Cogo E, Foerster V, Lefebvre C . PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. J Clin Epidemiol. 2016; 75:40-6. DOI: 10.1016/j.jclinepi.2016.01.021. View

Bi L, Yan B, Yang Q, Cui H . Peritoneal irrigation vs suction alone during pediatric appendectomy for perforated appendicitis: A meta-analysis. Medicine (Baltimore). 2019; 98(50):e18047. PMC: 6922395. DOI: 10.1097/MD.0000000000018047. View

Emile S, Hossam Elfallal A, Abdel-Razik M, El-Said M, Elshobaky A . A randomized controlled trial on irrigation of open appendectomy wound with gentamicin- saline solution versus saline solution for prevention of surgical site infection. Int J Surg. 2020; 81:140-146. DOI: 10.1016/j.ijsu.2020.07.057. View

Strobel R, Leonhardt M, Krochmann A, Neumann K, Speichinger F, Hartmann L . Reduction of Postoperative Wound Infections by Antiseptica (RECIPE)?: A Randomized Controlled Trial. Ann Surg. 2019; 272(1):55-64. DOI: 10.1097/SLA.0000000000003645. View

Horan T, Gaynes R, Martone W, Jarvis W, Emori T . CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992; 13(10):606-8. View

Zhao L, Zhang W, Liu K, Chen X, Yang K, Chen X . Comparing the efficacy of povidone-iodine and normal saline in incisional wound irrigation to prevent superficial surgical site infection: a randomized clinical trial in gastric surgery. J Hosp Infect. 2022; 131:99-106. DOI: 10.1016/j.jhin.2022.10.005. View

Burini G, Cianci M, Coccetta M, Spizzirri A, Di Saverio S, Coletta R . Aspiration versus peritoneal lavage in appendicitis: a meta-analysis. World J Emerg Surg. 2021; 16(1):44. PMC: 8419906. DOI: 10.1186/s13017-021-00391-y. View

10.

Guyatt G, Oxman A, Akl E, Kunz R, Vist G, Brozek J . GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011; 64(4):383-94. DOI: 10.1016/j.jclinepi.2010.04.026. View

11.

Niedner R . Cytotoxicity and sensitization of povidone-iodine and other frequently used anti-infective agents. Dermatology. 1997; 195 Suppl 2:89-92. DOI: 10.1159/000246038. View

12.

Mo Y, Choi J, Lee W . Prophylactic intraoperative wound irrigation with antibiotic solution for the prevention of surgical incisional wound infections: Systematic literature review and meta-analysis. J Plast Reconstr Aesthet Surg. 2022; 76:121-132. DOI: 10.1016/j.bjps.2022.10.014. View

13.

Khan K, Kumari J, Haider S, Fawwad S, Kumar N, Nizar R . The Prevalence and Etiology of Surgical Site Infections Following Gastrointestinal Tract Surgery: A Cross-Sectional Study From a Tertiary Care Hospital. Cureus. 2022; 14(7):e27320. PMC: 9411708. DOI: 10.7759/cureus.27320. View

14.

Ruiz-Tovar J, Santos J, Arroyo A, Llavero C, Armananzas L, Lopez-Delgado A . Effect of peritoneal lavage with clindamycin-gentamicin solution on infections after elective colorectal cancer surgery. J Am Coll Surg. 2012; 214(2):202-7. DOI: 10.1016/j.jamcollsurg.2011.10.014. View

15.

Fu C, Meng L, Ma M, Li N, Zhang J . Effect of wound irrigation on the prevention of surgical site infections: A meta-analysis. Int Wound J. 2022; 19(7):1878-1886. PMC: 9615282. DOI: 10.1111/iwj.13794. View

16.

Norman G, Atkinson R, Smith T, Rowlands C, Rithalia A, Crosbie E . Intracavity lavage and wound irrigation for prevention of surgical site infection. Cochrane Database Syst Rev. 2017; 10:CD012234. PMC: 5686649. DOI: 10.1002/14651858.CD012234.pub2. View

17.

Maemoto R, Noda H, Ichida K, Miyakura Y, Kakizawa N, Machida E . Aqueous Povidone-Iodine Versus Normal Saline For Intraoperative Wound Irrigation on The Incidence of Surgical Site Infection in Clean-Contaminated Wounds After Gastroenterological Surgery: A Single-Institute, Prospective, Blinded-Endpoint,.... Ann Surg. 2022; 277(5):727-733. DOI: 10.1097/SLA.0000000000005786. View

18.

Mueller T, Loos M, Haller B, Mihaljevic A, Nitsche U, Wilhelm D . Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg. 2015; 400(2):167-81. DOI: 10.1007/s00423-015-1279-x. View

19.

Gammeri E, Petrinic T, Bond-Smith G, Gordon-Weeks A . Meta-analysis of peritoneal lavage in appendicectomy. BJS Open. 2019; 3(1):24-30. PMC: 6354188. DOI: 10.1002/bjs5.50118. View

20.

Maatman T, Weber D, Timsina L, Qureshi B, Ceppa E, Nakeeb A . Antibiotic irrigation during pancreatoduodenectomy to prevent infection and pancreatic fistula: A randomized controlled clinical trial. Surgery. 2019; 166(4):469-475. DOI: 10.1016/j.surg.2019.05.053. View