Peritoneal lavage in abdominal sepsis. A controlled clinical study.

The value of intraoperative peritoneal lavage (IOPL) with saline solution, with or without antibiotics, in the treatment of peritoneal contamination, continues to be controversial. A prospective trial was carried out in 87 patients who underwent emergency laparotomies for peritonitis. They were randomized to be treated in one of three ways: group 1 (mean acute physiologic and chronic health evaluation [APACHE] II score, 8) received no IOPL; group 2 (mean APACHE II score, 10) received IOPL with saline solution; and group 3 (mean APACHE II score, 8) received IOPL with saline solution and 2 g of chloramphenicol succinate. In groups 1, 2, and 3, the mortality was 21%, 21%, and 10%, respectively (not significant), and correlated well with the preoperative APACHE II scores. In groups 1, 2, and 3, the mean hospital stay was 13, 13, and 10 days, respectively (not significant), and the incidence of wound infections was 20%, 17%, and 17%, respectively; the incidence of surgical complications was 10%, 24% and 7%, respectively (not significant), and of medical complications, 24%, 31%, and 17%, respectively. We concluded that IOPL with saline solution or antibiotics did not influence the outcome following laparotomies for peritonitis.