Intra-operative peritoneal lavage (IOPL)

 

I have been unable to find scientific evidence in the literature that irrigation of the abdominal cavity with antibiotics has any additional benefit than irrigation with saline alone. In fact, antibiotic irrigation may be harmful in that absorption of the antibiotic with toxic effects may occur.

Intra-operative peritoneal lavageI fully agree! We have reviewed all concerning literature about intra-operative peritoneal lavage (IOPL),concluding that there is NO evidence that IOPL with saline, ringer, antibiotic or antiseptics improves outcome of peritoneal contamination or infection. Subsequnetly we performed a randomized controlled trial comparing IOPL with saline, IOPL with antibiotics, and no IOPL (suction and swabbing only) again no difference.

We concluded that IOPL has no beneficial value in patients receving adequate wide spectrum peri-operative antibiotics.

Surgeons continue using IOPL and proudly announce at each conference how many liters they have used. This, however, satisfies more their cosmetic senses than the outcome of their patients.

Adverse effects of IOPL? Certainly Betadine may be toxic. You can add antibiotics which are rapidly absorbed and function systemically. Saline or ringer- the story about speard of infection is OUT. If you suck out completely the fluid- probably there is no harm; leaving it behind was described to diminish the peritoneal defense mechanisms as suggested by the discussants who mentioned the sweaming macrophages.

I do not use IOPL. Instead I suck and swab and argue with residents and nurses than want me to irrigate.

Many surgeons remain very emotional about sacrificing the sacred cow termed “generous IOPL”. A while ago an enthusiastic orrigator”shouted at me: “after you finish…do you flush or not flush the toliet?” . My answer to him was: it does not really matter whether you flush, suck or swab your …. after…. If you think it does, prove it!

Fowler position? Disputed before most of us was born. You can even stand in your bed but peritoneal fluid (contrast or isotope studies) migrate towards the diaphragm!

Leave a Reply

Your email address will not be published. Required fields are marked *