Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis
Abstract Background Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled t...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-03-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-023-00496-6 |
| _version_ | 1827974689275772928 |
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| author | Qi Zhou Wenbo Meng Yanhan Ren Qinyuan Li Marja A. Boermeester Peter Muli Nthumba Jennifer Rickard Bobo Zheng Hui Liu Qianling Shi Siya Zhao Zijun Wang Xiao Liu Zhengxiu Luo Kehu Yang Yaolong Chen Robert G. Sawyer |
| author_facet | Qi Zhou Wenbo Meng Yanhan Ren Qinyuan Li Marja A. Boermeester Peter Muli Nthumba Jennifer Rickard Bobo Zheng Hui Liu Qianling Shi Siya Zhao Zijun Wang Xiao Liu Zhengxiu Luo Kehu Yang Yaolong Chen Robert G. Sawyer |
| author_sort | Qi Zhou |
| collection | DOAJ |
| description | Abstract Background Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of IOPL in patients with IAIs. Methods The databases of PubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, and CBM databases were searched from inception to December 31, 2022. Random-effects models were used to calculate the risk ratio (RR), mean difference, and standardized mean difference. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence. Results Ten RCTs with 1318 participants were included, of which eight studies on appendicitis and two studies on peritonitis. Moderate-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (0% vs. 1.1%; RR, 0.31 [95% CI, 0.02–6.39]), intra-abdominal abscess (12.3% vs. 11.8%; RR, 1.02 [95% CI, 0.70–1.48]; I 2 = 24%), incisional surgical site infections (3.3% vs. 3.8%; RR, 0.72 [95% CI, 0.18–2.86]; I 2 = 50%), postoperative complication (11.0% vs. 13.2%; RR, 0.74 [95% CI, 0.39–1.41]; I 2 = 64%), reoperation (2.9% vs. 1.7%; RR,1.71 [95% CI, 0.74–3.93]; I 2 = 0%) and readmission (5.2% vs. 6.6%; RR, 0.95 [95% CI, 0.48–1.87]; I 2 = 7%) in patients with appendicitis when compared to non-IOPL. Low-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (22.7% vs. 23.3%; RR, 0.97 [95% CI, 0.45–2.09], I 2 = 0%) and intra-abdominal abscess (5.1% vs. 5.0%; RR, 1.05 [95% CI, 0.16–6.98], I 2 = 0%) in patients with peritonitis when compared to non-IOPL. Conclusion IOPL with saline use in patients with appendicitis was not associated with significantly decreased risk of mortality, intra-abdominal abscess, incisional surgical site infection, postoperative complication, reoperation, and readmission compared with non-IOPL. These findings do not support the routine use of IOPL with saline in patients with appendicitis. The benefits of IOPL for IAI caused by other types of abdominal infections need to be investigated. |
| first_indexed | 2024-04-09T19:58:24Z |
| format | Article |
| id | doaj.art-3c1864c6ab764fc2b98aaf2159d1d666 |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-04-09T19:58:24Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-3c1864c6ab764fc2b98aaf2159d1d6662023-04-03T05:20:41ZengBMCWorld Journal of Emergency Surgery1749-79222023-03-0118111310.1186/s13017-023-00496-6Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysisQi Zhou0Wenbo Meng1Yanhan Ren2Qinyuan Li3Marja A. Boermeester4Peter Muli Nthumba5Jennifer Rickard6Bobo Zheng7Hui Liu8Qianling Shi9Siya Zhao10Zijun Wang11Xiao Liu12Zhengxiu Luo13Kehu Yang14Yaolong Chen15Robert G. Sawyer16Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou UniversityDepartment of General Surgery, The First Hospital of Lanzhou UniversityUniversity of Massachusetts Chan Medical SchoolDepartment of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of PediatricsDepartment of Surgery, Amsterdam UMC Location AMC, University of AmsterdamDepartment of Plastic Surgery, AIC Kijabe HospitalDepartment of Surgery, University of MinnesotaDepartment of Gastrointestinal Surgery, West China Hospital, Sichuan UniversitySchool of Public Health, Lanzhou UniversityThe First School of Clinical Medicine, Lanzhou UniversitySchool of Public Health, Lanzhou UniversityEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou UniversitySchool of Public Health, Lanzhou UniversityDepartment of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of PediatricsEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou UniversityEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou UniversityDepartment of Surgery, Western Michigan University School of MedicineAbstract Background Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of IOPL in patients with IAIs. Methods The databases of PubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, and CBM databases were searched from inception to December 31, 2022. Random-effects models were used to calculate the risk ratio (RR), mean difference, and standardized mean difference. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence. Results Ten RCTs with 1318 participants were included, of which eight studies on appendicitis and two studies on peritonitis. Moderate-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (0% vs. 1.1%; RR, 0.31 [95% CI, 0.02–6.39]), intra-abdominal abscess (12.3% vs. 11.8%; RR, 1.02 [95% CI, 0.70–1.48]; I 2 = 24%), incisional surgical site infections (3.3% vs. 3.8%; RR, 0.72 [95% CI, 0.18–2.86]; I 2 = 50%), postoperative complication (11.0% vs. 13.2%; RR, 0.74 [95% CI, 0.39–1.41]; I 2 = 64%), reoperation (2.9% vs. 1.7%; RR,1.71 [95% CI, 0.74–3.93]; I 2 = 0%) and readmission (5.2% vs. 6.6%; RR, 0.95 [95% CI, 0.48–1.87]; I 2 = 7%) in patients with appendicitis when compared to non-IOPL. Low-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (22.7% vs. 23.3%; RR, 0.97 [95% CI, 0.45–2.09], I 2 = 0%) and intra-abdominal abscess (5.1% vs. 5.0%; RR, 1.05 [95% CI, 0.16–6.98], I 2 = 0%) in patients with peritonitis when compared to non-IOPL. Conclusion IOPL with saline use in patients with appendicitis was not associated with significantly decreased risk of mortality, intra-abdominal abscess, incisional surgical site infection, postoperative complication, reoperation, and readmission compared with non-IOPL. These findings do not support the routine use of IOPL with saline in patients with appendicitis. The benefits of IOPL for IAI caused by other types of abdominal infections need to be investigated.https://doi.org/10.1186/s13017-023-00496-6Intraoperative peritoneal lavageIntra-abdominal infectionMeta-analysis |
| spellingShingle | Qi Zhou Wenbo Meng Yanhan Ren Qinyuan Li Marja A. Boermeester Peter Muli Nthumba Jennifer Rickard Bobo Zheng Hui Liu Qianling Shi Siya Zhao Zijun Wang Xiao Liu Zhengxiu Luo Kehu Yang Yaolong Chen Robert G. Sawyer Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis World Journal of Emergency Surgery Intraoperative peritoneal lavage Intra-abdominal infection Meta-analysis |
| title | Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis |
| title_full | Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis |
| title_fullStr | Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis |
| title_full_unstemmed | Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis |
| title_short | Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis |
| title_sort | effectiveness of intraoperative peritoneal lavage with saline in patient with intra abdominal infections a systematic review and meta analysis |
| topic | Intraoperative peritoneal lavage Intra-abdominal infection Meta-analysis |
| url | https://doi.org/10.1186/s13017-023-00496-6 |
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