Mechanically assisted intraoperative peritoneal lavage for generalized peritonitis as a result of perforation of the upper part of the gastrointestinal tract.

BACKGROUND

The efficiency of intraoperative peritoneal lavage (IOPL) and peritoneal drainage in patients with generalized peritonitis remains controversial. The benefit of large volume IOPL, using a newly designed device, and of peritoneal drainage were evaluated in 101 patients with generalized peritonitis.

STUDY DESIGN

Patients were divided into two groups, one treated by mechanically assisted IOPL (group 1), and the other treated by manual IOPL (group 2). They were further divided into two groups, one undergoing drainage (DR group) and the other undergoing no drainage (ND group). Based on data in the progress notes, patients in these groups were compared with each other with respect to disease process, volume of IOPL fluid, incidence of infectious complications, and other prognostic factors.

RESULTS

In group 1, the incidence of infectious complications was significantly lower than in group 2 (10.8 versus 62.9 percent, p < 0.01). Patients who underwent operative treatment 12 hours or more after onset of peritonitis had a lower incidence of infection following high volume IOPL (greater than or equal to 30 L) compared with those patients who underwent low volume IOPL. The incidence of infectious complications was significantly higher in the DR group (32.8 versus 12.9 percent).

CONCLUSIONS

A large volume of saline (greater than or equal to 30 L) was needed for IOPL. The new device for IOPL proved to be very successful and efficient. When IOPL was successful, it seemed that peritoneal drainage did not provide any additional benefits to the treatment of generalized peritonitis.