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

Cicco, Carlo De; Schonman, Ron; Ussia, Anastasia; Koninckx, Philippe

doi:10.1007/s10397-015-0897-1

Cited by 5 publications

(6 citation statements)

References 32 publications

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“…Five studies (reported in six publications) are pending assessment ( De Cicco 2015 ; De Kok 1998 ; Kosuş 2010 ; Munoz‐Mahamud 2011 ; Taylor 1999 ). In each case there were no relevant review outcomes reported; we have attempted to contact study authors without success to date in four cases.…”

Section: Resultsmentioning

confidence: 99%

“…In each case there were no relevant review outcomes reported; we have attempted to contact study authors without success to date in four cases. In the case of De Cicco 2015 a further publication with relevant data is pending but the corresponding author was unable to supply this in advance of publication. We were able to exclude a further study after author contact confirmed that the purpose of the study was outside the scope of this review and no relevant outcome data were available ( Keblawi 2006 ) (see Excluded studies ).…”

Section: Resultsmentioning

confidence: 99%

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Intracavity lavage and wound irrigation for prevention of surgical site infection

Norman

Atkinson

Smith

et al. 2017

Cochrane Database of Systematic Reviews

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BackgroundSurgical site infections (SSIs) are wound infections that occur after an operative procedure. A preventable complication, they are costly and associated with poorer patient outcomes, increased mortality, morbidity and reoperation rates. Surgical wound irrigation is an intraoperative technique, which may reduce the rate of SSIs through removal of dead or damaged tissue, metabolic waste, and wound exudate. Irrigation can be undertaken prior to wound closure or postoperatively. Intracavity lavage is a similar technique used in operations that expose a bodily cavity; such as procedures on the abdominal cavity and during joint replacement surgery.ObjectivesTo assess the effects of wound irrigation and intracavity lavage on the prevention of surgical site infection (SSI).Search methodsIn February 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions on language, date of publication or study setting.Selection criteriaWe included all randomised controlled trials (RCTs) of participants undergoing surgical procedures in which the use of a particular type of intraoperative washout (irrigation or lavage) was the only systematic difference between groups, and in which wounds underwent primary closure. The primary outcomes were SSI and wound dehiscence. Secondary outcomes were mortality, use of systemic antibiotics, antibiotic resistance, adverse events, re-intervention, length of hospital stay, and readmissions.Data collection and analysisTwo review authors independently assessed studies for inclusion at each stage. Two review authors also undertook data extraction, assessment of risk of bias and GRADE assessment. We calculated risk ratios or differences in means with 95% confidence intervals where possible.Main resultsWe included 59 RCTs with 14,738 participants. Studies assessed comparisons between irrigation and no irrigation, between antibacterial and non-antibacterial irrigation, between different antibiotics, different antiseptics or different non-antibacterial agents, or between different methods of irrigation delivery. No studies compared antiseptic with antibiotic irrigation.Surgical site infectionIrrigation compared with no irrigation (20 studies; 7192 participants): there is no clear difference in risk of SSI between irrigation and no irrigation (RR 0.87, 95% CI 0.68 to 1.11; I2 = 28%; 14 studies, 6106 participants). This would represent an absolute difference of 13 fewer SSIs per 1000 people treated with irrigation compared with no irrigation; the 95% CI spanned from 31 fewer to 10 more SSIs. This was low-certainty evidence downgraded for risk of bias and imprecision.Antibacterial irrigation compared with non-antibacterial irrigation (36 studies, 6163 participants): there may be a lower incidence of SSI in participants treated with antibacterial ir...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Intracavity lavage and wound irrigation for prevention of surgical site infection

Norman

Atkinson

Smith

et al. 2017

Cochrane Database of Systematic Reviews

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“…The reason for the decrease in pain might be related to a reduction in the inflammatory response. Pain perception is often triggered by local release of cytokines from inflammatory cells and is a clinical reflection of tissue damage and the inflammatory response . Schwarz et al and Kalff et al also found a postoperative inflammatory field-effect phenomenon within the manipulated gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 99%

Combined Surgery and Extensive Intraoperative Peritoneal Lavage vs Surgery Alone for Treatment of Locally Advanced Gastric Cancer

Guo

Sun

et al. 2019

JAMA Surg

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IMPORTANCE Peritoneal metastasis is the most frequent pattern of postoperative recurrence in patients with gastric cancer. Extensive intraoperative peritoneal lavage (EIPL) is a new prophylactic strategy for treatment of peritoneal metastasis of locally advanced gastric cancer; however, the safety and efficacy of EIPL is currently unknown.OBJECTIVE To evaluate short-term outcomes of patients with advanced gastric cancer who received combined surgery and EIPL or surgery alone. DESIGN, SETTING, AND PARTICIPANTS From March 2016 to November 2017, 662 patients with advanced gastric cancer receiving D2 gastrectomy were enrolled in a large, multicenter, randomized clinical trial from 11 centers across China. In total, 329 patients were randomly assigned to receive surgery alone, and 333 patients were randomly assigned to receive surgery plus EIPL. Clinical characteristics, operative findings, and postoperative short-term outcomes were compared between the 2 groups in the intent-to-treat population.MAIN OUTCOMES AND MEASURES Short-term postoperative complications and mortality. RESULTSThe present analysis included data from 550 patients, 390 men and 160 women, with a mean (SD) age of 60.8 (10.7) years in the surgery alone group and 60.6 (10.8) in the surgery plus EIPL group. Patients assigned to the surgery plus EIPL group exhibited reduced mortality (0 of 279 patients) compared with those assigned to surgery alone (5 of 271 patients [1.9%]) (difference, 1.9%; 95% CI, 0.3%-3.4%; P = .02). A significant difference in the overall postoperative complication rate was observed between patients receiving surgery alone (46 patients [17.0%]) and those receiving surgery plus EIPL (31 patients [11.1%]) (difference, 5.9%; 95% CI, 0.1%-11.6%; P = .04). Postoperative pain occurred more often following surgery alone (48 patients [17.7%]) than following surgery plus EIPL (30 patients [10.8%]) (difference, 7.0%; 95% CI, 0.8%-13.1%; P = .02).CONCLUSIONS AND RELEVANCE Inclusion of EIPL can increase the safety of D2 gastrectomy and decrease postoperative short-term complications and wound pain. As a new, safe, and simple procedure, EIPL therapy is easily performed anywhere and does not require any special devices or techniques. Our study suggests that patients with advanced gastric cancer appear to be candidates for the EIPL approach.

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“…It is suggested that lavage should include the upper abdomen if it is contaminated with blood or debris and continued until the liquid is clear. Indeed, after full-thickness resection or deep endometriosis, significantly lower postoperative C-reactive protein concentrations were found after lavage with 8 L versus 0.5 L, suggesting less inflammation (125). This obviously also applies to all situations with an increased risk of infection, such as when the vagina has been opened, when the bowel is entered, or in the presence of an abscess.…”

Section: Adhesion Prevention Strategy In Humans Prevention Of Adhesion Formationmentioning

confidence: 98%

Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue

Koninckx¹,

Gomel

Ussia³

et al. 2016

Fertility and Sterility

Self Cite

113

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A surgical trauma results within minutes in exudation, platelets, and fibrin deposition. Within hours, the denuded area is covered by tissue repair cells/macrophages, starting a cascade of events. Epithelial repair starts on day 1 and is terminated by day 3. If repair is delayed by decreased fibrinolysis, local inflammation, or factors in peritoneal fluid, fibroblast growth starting on day 3 and angiogenesis starting on day 5 results in adhesion formation. For adhesion formation, quantitatively more important are factors released into the peritoneal fluid after retraction of the fragile mesothelial cells and acute inflammation of the entire peritoneal cavity. This is caused by mechanical trauma, hypoxia (e.g., CO pneumoperitoneum), reactive oxygen species (ROS; e.g., open surgery), desiccation, or presence of blood, and this is more severe at higher temperatures. The inflammation at trauma sites is delayed by necrotic tissue, resorbable sutures, vascularization damage, and oxidative stress. Prevention of adhesion formation therefore consists of the prevention of acute inflammation in the peritoneal cavity by means of gentle tissue handling, the addition of more than 5% NO to the CO pneumoperitoneum, cooling the abdomen to 30°C, prevention of desiccation, a short duration of surgery, and, at the end of surgery, meticulous hemostasis, thorough lavage, application of a barrier to injury sites, and administration of dexamethasone. With this combined therapy, nearly adhesion-free surgery can be performed today. Conditioning alone results in some 85% adhesion prevention, barriers alone in 40%-50%.

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

Cited by 5 publications

References 32 publications

Intracavity lavage and wound irrigation for prevention of surgical site infection

Intracavity lavage and wound irrigation for prevention of surgical site infection

Combined Surgery and Extensive Intraoperative Peritoneal Lavage vs Surgery Alone for Treatment of Locally Advanced Gastric Cancer

Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue

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