Title: Intraoperative Lavage in Patients Undergoing Emergency Laparotomy for Prevention of Wound Infection:  A Comparitive Study between Normal Saline and Metronidazole

Authors: Dr Mohit Gangwal, Dr Atul Kumar Singh (M.S.), Dr Brijesh Singh (M.S.), Dr A.P.S. Gaharwar (M.S.)

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i3.47

Abstract

Intraoperative peritoneal lavage plays an important role in a treatment of peritonitis. Sterile water, warm saline, and povidone-iodine are most commonly used for the purpose of peritoneal lavage. But now, the addition of antibiotics in these fluids is supposed to give better results. Among various antibiotics, metronidazole has proved to be most beneficial in treating the peritonitis.

Materials and Methods: 271 patients who got admitted through SOPD, casualty or transferred from other departments and underwent emergency laparotomy during the period of study were included in the study irrespective of the age and sex. Patients were randomly distributed into two groups.

One received intraoperative peritoneal lavage with 5 litres of normal saline and others received lavage with 5 litres of normal saline along with 100ml of metronidazole.

Post operative wound infections were recorded. Results of both the groups were analyzed statistically with the help of chi square test. P value of < 0.05 was considered statistically significant.

Results:  The mean age of the patients in our study was 36.1 and standard deviation of 15

Out of 271 patients, 219 were males 52 were females. Most common etiology of peritonitis was Peptic perforation (35.4%) followed by ileal perforation (23.6%)

Wound s\infections were statistically more with patients who received only normal saline for lavage as compared to patients with normal saline and topical metronidazole.

Conclusion: Addition of peritoneal lavage with high concentrations of appropriate antibiotics in saline combined with the basic principles of good surgery and the systemic administration of antibiotics, offers the patient a much better chance to recover and has few if any ill effects.

Keywords: Peritonitis, Lavage, Metronidazole, Wound infection.

References

1.      Schein M, Gecelter G, Freinkel W, Gerding H, Becker PJ. Peritoneal lavage in abdominal sepsis. A controlled clinical study. Arch Surg 1990;125:1132-5.

2.      Myers E, Hurley M, O’Sullivan GC, Kavanagh D, Wilson I, Winter DC. Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 2008;95:97-101.

3.      Zhao K, Kirman I, Tschepen I, Schwab R, Weksler ME. Peritoneal lavage reduces lipopolysaccharide-induced elevation of serum TNF-alpha and IL-6 mortality in mice. Inflammation 1997;21:379-90.

4.      Johnson CC, Baldessarre J, Levison ME. Peritonitis: Update on  pathophysiology, clinical manifestations, and management. Clin Infect Dis 1997;24:1035-45.

5.      Rambo WM. Irrigation of the peritoneal cavity with cephalothin. Am J Surg  1972;123:192-5.

6.      Broderick T, Matthews J. Ulcer complications. In: Zinner M, Ashley  S, editors. Maingots Abdominal Operations. 11thed. Philadelphia, PA: McGraw Hill Medical; 2007. p. 253-6.

7.      Singh H, Agrawal M, Singh NK, Kaul RK, Ilahi I, Ahuja R. Intraoperative Lavage in Peritonitis: Comparison between Saline and Metronidazole. Int J Sci Stud 2016; 4(3):131-134.

8.      Dalvi AN, Gondhalekar RA, Upadhye AS. Post-operative irrigation in the management of amoebic peritonitis. J Postgrad Med 1987; 33:61-4.

Corresponding Author

Dr Mohit Gangwal

Address: D-163, Scheme no 51, Sanagm Nagar, Indore, (MP) 452006

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Phone numbers: 8103676828