Meta-analysis of the effect of peritoneal lavage on survival in experimental peritonitis.

ABSTRACT

BACKGROUND: Morbidity and mortality associated with bacterial peritonitis remain a challenge for contemporary surgery. Despite great surgical improvements, death rates have not improved. A secondary debate concerns the volume and nature of peritoneal lavage or washout-what volume, what carrier and what, if any, antibiotic or antiseptic? METHODS: A literature search of experimental studies assessing the effect of peritoneal lavage following peritonitis was conducted using Medline, EMBASE and Cochrane databases. Twenty-three trials met predetermined inclusion criteria. Data were pooled and relative risks calculated. RESULTS: In an experimental peritonitis setting a mortality rate of 48.9 per cent (238 of 487) was found for saline lavage compared with 16.4 per cent (106 of 647) for antibiotic lavage (absolute risk reduction (ARR) 32.5 (95 per cent confidence interval (c.i.) 27.1 to 37.7) per cent; (P < 0.001). An ARR of 25.0 (95 per cent c.i. 17.9 to 31.7) per cent P < 0.001) was found for the use of saline compared with no lavage at all. The survival benefit persisted regardless of systemic antibiotic therapy. Antiseptic lavage was associated with a very high mortality rate (75.0 per cent). CONCLUSION: Pooled data from studies in experimental peritonitis demonstrated a significant reduction in mortality with antibiotic lavage.