Wound irrigation and peritoneal lavage with antiseptic/antibiotic solution before wound closure during gastrointestinal surgery: a systematic review and meta-analysis.

Masahiro Kobayashi, Hiroshi Nobuhara, Yuki Hanai, Motomu Kobayash, Yuichi Kitagawa, Chizuru Yamashita, Junzo Shimizu, Tomohiro Ishinuki, Hiroji Shinkawa, Keita Kouzu, Hiroki Ohge, Masahiro Yoshida, Hiroki Imaoka, Motoi Uchino, Koji Tamura, Toshihiko Mayumi, Seiji Haji, Toru Mizuguchi, Hiroki Ikeuchi, Yasuhiko Mohri, Seiichi Shinji, Shinsuke Nomura, Katsunori Suzuki

Journal: BMC surgery 2025;25(1):38

PMID: 39849481

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Abstract

BACKGROUND

Surgical site infections (SSIs) can affect mortality, morbidity, and medical costs. Although it has recently been reported that washing with antiseptic/antibiotic solution can prevent SSI in clean surgery, the clinical impact in gastrointestinal surgery is still uncertain. Therefore, we performed a systematic review and meta-analysis to evaluate the efficacy of antiseptic/antibiotic solution during wound irrigation or peritoneal lavage in gastroenterological surgery.

METHODS

The database search used PubMed, MEDLINE, and Cochrane Library. The following inclusion criteria were set for the systematic review. 1) Studies comparing with or without antiseptic/antibiotic irrigation/lavage during gastrointestinal surgery. 2) Studies that described surgical site infections and adverse events. 3) Studies conducted after 2000.

RESULTS

A total of 8 randomized controlled studies (RCTs) and 3 observational studies were included in this meta-analysis. Three RCTs of wound irrigation with povidone iodine (PVI) solution revealed no significant difference between the PVI and control groups [RR 1.41, 95% CI (0.92 to 2.17): p = 0.69]. Three RCTs of peritoneal lavage with antibiotic solution showed no significant difference between the interventional group and control groups [RR 0.39, 95% CI (0.10 to 1.55): p = 0.18]. Regarding other antiseptic or antibiotic solutions, the number of studies and participants were too small for evaluation.

CONCLUSION

Wound irrigation and peritoneal lavage with antiseptic/antibiotic solution did not have enough efficacy for preventing SSI during gastroenterological surgery.

Address: Department of Gastroenterological Surgery, Division of Inflammatory Bowel Disease, Hyogo Medical University, 1-1, Mukogawacho, Nishinomiya, Hyogo, Japan. [email protected].; Department of Surgery and Oncology Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.; Department of Surgery, Hayamizu-Park Clinic, Miyazaki, Japan.; Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Bunkyo, Japan.; Department of Surgery, National Defence Medical College, Tokorozawa, Japan.; Department of Hepatobiliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.; Department of Nursing, Division of Surgical Science, Sapporo Medical University, Sapporo, Japan.; Department of Infectious Disease, Hiroshima University Hospital, Hiroshima, Japan.; Department of Surgery, Soseikai General Hospital, Kyoto, Japan.; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan.; Department of Gastrointestinal Surgery, Mie Prefectural General Medical Center, Mie, Japan.; Department of Anesthesiology and Critical Care Medicine, Fujita Health University, Toyoake, Aichi, Japan.; Department of Gastrointestinal Surgery, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.; Department of Infection Control, Hospital of the University of Occupational and Environmental Health, Fukuoka, Japan.; Department of Anesthesiology, Hokushinkai Megumino Hospital, Hokkaido, Japan.; Department of Clinical Pharmacokinetics, Research and Education Center for Clinical Pharmacy, Kitasato University Hospital, Sagamihara, Kanagawa, Japan.; Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Ota, Japan.; Department of Dentistry, Hiroshima Prefectural Hospital, Hiroshima, Japan.; Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan.; Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Otawara, Japan.; Department of Intensive Care Unit, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan.; Department of Gastroenterological Surgery, Division of Inflammatory Bowel Disease, Hyogo Medical University, 1-1, Mukogawacho, Nishinomiya, Hyogo, Japan.

DOI: 10.1186/s12893-025-02774-3

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MeSH Terms: Humans, Peritoneal Lavage, Surgical Wound Infection, Anti-Infective Agents, Local, Therapeutic Irrigation, Digestive System Surgical Procedures, Anti-Bacterial Agents