Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis

作者全名："Zhou, Qi; Meng, Wenbo; Ren, Yanhan; Li, Qinyuan; Boermeester, Marja A.; Nthumba, Peter Muli; Rickard, Jennifer; Zheng, Bobo; Liu, Hui; Shi, Qianling; Zhao, Siya; Wang, Zijun; Liu, Xiao; Luo, Zhengxiu; Yang, Kehu; Chen, Yaolong; Sawyer, Robert G."

作者地址："[Zhou, Qi; Wang, Zijun; Yang, Kehu; Chen, Yaolong] Lanzhou Univ, Sch Basic Med Sci, Evidence Based Med Ctr, Lanzhou, Peoples R China; [Meng, Wenbo] Lanzhou Univ, Hosp 1, Dept Gen Surg, Lanzhou, Peoples R China; [Ren, Yanhan] Univ Massachusetts, Chan Med Sch, Worcester, MA USA; [Li, Qinyuan; Luo, Zhengxiu] Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Key Lab Dev & Disorders,Chongqing Key Lab Pediat, Dept Resp Med,Childrens Hosp,Minist Educ, Chongqing, Peoples R China; [Boermeester, Marja A.] Univ Amsterdam, Amsterdam UMC Locat AMC, Dept Surg, Amsterdam, Netherlands; [Boermeester, Marja A.] Amsterdam Gastroenterol Endocrinol & Metab, Amsterdam, Netherlands; [Nthumba, Peter Muli] AIC Kijabe Hosp, Dept Plast Surg, Kijabe, Kenya; [Nthumba, Peter Muli] Vanderbilt Univ, Med Ctr, Nashville, TN USA; [Rickard, Jennifer] Univ Minnesota, Dept Surg, Minneapolis, MN USA; [Zheng, Bobo] Sichuan Univ, West China Hosp, Dept Gastrointestinal Surg, Chengdu, Peoples R China; [Liu, Hui; Zhao, Siya; Liu, Xiao] Lanzhou Univ, Sch Publ Hlth, Lanzhou, Peoples R China; [Shi, Qianling] Lanzhou Univ, Sch Clin Med 1, Lanzhou, Peoples R China; [Chen, Yaolong] Lanzhou Univ, Chinese Acad Med Sci 2021RU017, Sch Basic Med Sci, Res Unit Evidence Based Evaluat & Guidelines, Lanzhou, Peoples R China; [Chen, Yaolong] Chongqing Med Univ, Childrens Hosp, Chevidence Lab Child & Adolescent Hlth, Chongqing, Peoples R China; [Sawyer, Robert G.] Western Michigan Univ, Sch Med, Dept Surg, Kalamazoo, MI USA"

通信作者："Chen, YL (通讯作者)，Lanzhou Univ, Sch Basic Med Sci, Evidence Based Med Ctr, Lanzhou, Peoples R China.; Chen, YL (通讯作者)，Lanzhou Univ, Chinese Acad Med Sci 2021RU017, Sch Basic Med Sci, Res Unit Evidence Based Evaluat & Guidelines, Lanzhou, Peoples R China.; Chen, YL (通讯作者)，Chongqing Med Univ, Childrens Hosp, Chevidence Lab Child & Adolescent Hlth, Chongqing, Peoples R China."

来源：WORLD JOURNAL OF EMERGENCY SURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000988340800002

JCR分区：Q1

影响因子：6

年份：2023

卷号：18

期号：1

开始页：　

结束页：　

文献类型：Review

关键词：Intraoperative peritoneal lavage; Intra-abdominal infection; Meta-analysis

摘要："BackgroundIntraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of IOPL in patients with IAIs.MethodsThe databases of PubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, and CBM databases were searched from inception to December 31, 2022. Random-effects models were used to calculate the risk ratio (RR), mean difference, and standardized mean difference. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence.ResultsTen RCTs with 1318 participants were included, of which eight studies on appendicitis and two studies on peritonitis. Moderate-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (0% vs. 1.1%; RR, 0.31 [95% CI, 0.02-6.39]), intra-abdominal abscess (12.3% vs. 11.8%; RR, 1.02 [95% CI, 0.70-1.48]; I-2 = 24%), incisional surgical site infections (3.3% vs. 3.8%; RR, 0.72 [95% CI, 0.18-2.86]; I-2 = 50%), postoperative complication (11.0% vs. 13.2%; RR, 0.74 [95% CI, 0.39-1.41]; I-2 = 64%), reoperation (2.9% vs. 1.7%; RR,1.71 [95% CI, 0.74-3.93]; I-2 = 0%) and readmission (5.2% vs. 6.6%; RR, 0.95 [95% CI, 0.48-1.87]; I-2 = 7%) in patients with appendicitis when compared to non-IOPL. Low-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (22.7% vs. 23.3%; RR, 0.97 [95% CI, 0.45-2.09], I-2 = 0%) and intra-abdominal abscess (5.1% vs. 5.0%; RR, 1.05 [95% CI, 0.16-6.98], I-2 = 0%) in patients with peritonitis when compared to non-IOPL.ConclusionIOPL with saline use in patients with appendicitis was not associated with significantly decreased risk of mortality, intra-abdominal abscess, incisional surgical site infection, postoperative complication, reoperation, and readmission compared with non-IOPL. These findings do not support the routine use of IOPL with saline in patients with appendicitis. The benefits of IOPL for IAI caused by other types of abdominal infections need to be investigated."

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