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

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.