Efficacy of imipenem lavage versus saline lavage in perforation peritonitis

Santhosh C. S.; Avinash Chandra Singh; Karan K. Shetty

doi:10.18203/2349-2902.isj20182079

Authors

Santhosh C. S. Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
Avinash Chandra Singh Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
Karan K. Shetty Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20182079

Keywords:

Imipenem, Laparotomy, Perforation peritonitis, Peritoneal lavage, Post-operative complications

Abstract

Background: Surgical treatment for perforation peritonitis is still believed to be demanding and complex in spite of the advent of better surgical technique, antimicrobial therapy and intensive care support improving the outcome of such cases. However, the specific details of the pre-operative, intra-operative and post-operative management have always been very controversial and debatable. This study aims to evaluate the efficacy of peritoneal cavity irrigation with imipenem solution in patients with perforation peritonitis and compare it with standard saline wash.

Methods: This study was conducted in a tertiary care teaching hospital from November 2015 to April 2017 and included 90 patients aged between 12 and 60 years who are operated for perforation peritonitis. Patients are divided into 3 groups and underwent post laparotomy irrigation as follows saline and fluid drained, saline and then imipenem wash at a concentration of 1mg/ml and fluid drained after 5 minutes, saline and then imipenem wash at a concentration of 1 mg/ml and drain was clamped for 1 hour. The patients were then observed for post-operative complications.

Results: There was a statistically significant reduction in post-operative wound infection (33.33%), intra-abdominal abscess (23.33%) and sepsis (23.33%) in group 3 when compared to other two groups. Group 3 had a much lower mortality rate (3.33%) when compared to the other two (16.67% and 6.67% respectively.)

Conclusions: Addition of Imipenem to normal saline for intraoperative peritoneal lavage has much satisfactory post-operative outcome. Further studies with larger sample size are needed to accurately assess the statistical significance of the same.

Metrics

Metrics Loading ...

References

Jhobta et al. Spectrum of perforation peritonitis in India-review of 504 consecutive cases. World general of emergency surgery 2006;26(1):1749-7922.

Yadav D, Garg PK. Spectrum of Perforation Peritonitis in Delhi: 77 Cases Experience. Indian J Surg 2013; 75(2):133–7.

Hesami MA et al. Irrigation of Abdomen With Imipenem Solution Decreases Surgical Site Infections in Patients With Perforated Appendicitis: A Randomized Clinical Trial. Iran Red Crescent Med J 2014; 16(4): e12732.

Parcells JP, Mileski JP, Gnagy FT, Haragan AF, Mileski WJ. Using antimicrobial solution for irrigation in appendicitis to lower surgical site infection rates. Am J Surg 2009;198(6):875–80.

Sheeraz M , A K Verma, Mohd. Shahid, Manal M K, Abrar A. Evaluation of Pre-Operative Peritoneal Lavage by Superoxidized Solution in Peritonitis. Middle east journal of internal medicine. 2009; 2, 3:15-33.

M. Schein, R. Saadia Mr, Z. Freinkel, G. A. G. Decker. Aggressive treatment of severe diffuse peritonitis: A prospective study, British Journal of Surgery 1988; 75, 2, 173–76.

Fowler R J; A controlled trial of intraperitoneal cephaloridine administration

peritonitis. J Paediatric Surg. 1975; 10, 43-50.

Hesami MA, Alipour H, Daylami HN, Alipour B, Bazargan-Hejazi S, Ahmadi A. Irrigation of abdomen with imipenem solution decreases surgical site infections in patients with perforated appendicitis: a randomized clinical trial. Iranian Red Crescent Medical Journal. 2014 Apr;16(4).

Silverman SH, Ambrose NS, Youngs DJ, Shepherd AF, Roberts AP, Keighley MR. The effect of peritoneal lavage with tetracycline solution on postoperative infection. Diseases of the colon & rectum. 1986 Mar 1;29(3):165-9.

DiVincenti FC, Cohn Jr I. Prolonged administration of intraperitoneal kanamycin in the treatment of peritonitis. The American surgeon. 1971 Apr;37(4):177.

Rambo and et al Antibiotic Concentrations in Ascitic Fluid of Patients with Ascites and Bacterial Peritonitis June 1977 Annals of Internal Medicine ;Volume 86 , Number 6,708-13.

McKenna JP, Currie DJ, MacDonald JA, Mahoney LJ, Finlayson DC, Lanskail JC. The use of continuous postoperative peritoneal lavage in the management of diffuse peritonitis. Surgery, gynecology & obstetrics. 1970 Feb;130(2):254.

Bhushan C, Mital VK, Elhence IP. Continuous postoperative peritoneal lavage in diffuse peritonitis using balanced saline antibiotic solution. International surgery. 1975 Oct;60(10):526-8.