A prospective randomized study of continuous peritoneal lavage postoperatively in the treatment of purulent peritonitis.

Peritoneal lavage performed postoperatively in the treatment of purulent peritonitis was evaluated in a prospective randomized study. Patients with free purulent peritonitis due to perforated appendicitis or colonic perforation were treated with intravenous infusion of cefuroxime and metronidazole. The patients were randomly allocated to treatment with or without continuous postoperative peritoneal lavage. The patients were kept under observation for postoperative septic intra-abdominal complications. Of the 79 patients, 41 were treated with lavage postoperatively and 38 were not. No postoperative abscess or other septic intra-abdominal complication was found in any patient. In ten, the postoperative lavage was interrupted because of technical complications or complaints of discomfort by the patient. In this study, no clinical benefit of continuous peritoneal lavage postoperatively in the treatment of purulent peritonitis was noted. Lavage done postoperatively is expensive and seems to carry a risk of complications. Thorough rinsing of the infected abdominal cavity perioperatively and adequate antibiotic treatment, including an antianaerobic agent, seem to be effective in preventing intra-abdominal septic complications.