Abstract
A COMPARISION BETWEEN METROGYL AND NORMAL WARM SALINE INTRAOPERATIVE PERITONEAL LAVAGE IN PREVENTION OF POST OPERATIVE ABDOMEN DEHISCENSE: A PROSPECTIVE STUDY

Dr. Ashwani Gupta, Dr. Vimal Bhandari, Dr. Ashish*, Dr. Prabhaker Krishna, Dr.Tarun Singh and Dr. Aman Chopra

ABSTRACT

Intra-abdominal sepsis is associated with high morbidity and mortality mostly arising from peritonitis caused by perforated peptic ulcer, typhoid ulcer, appendix and other causes of gangrenous gut. Peritonitis is defined as the inflammation of thin tissue layer surrounding the abdominal organs. Acute generalized peritonitis is considered as the surgical emergency. Sequestration of fluid and electrolytes result in electrolyte imbalance leading to hypovolemia and finally shock or acute renal failure. Surgeons are able to reduce systemic infection, but SSI remains a challenge where incidence still may be as high as 60-70%.[1] General supportive measures such as maintenance of hydration, correction of electrolytes imbalance and intravenous antibiotics are provided. The mainstay of the treatment in case of perforation is the surgical closure. Along with this, intraoperative peritoneal lavage plays an important role in the treatment of peritonitis.[2-4] The mode of action of this method is that it decreases the load of bacteria, thus reducing the severity of disease and hastens the recovery of the patient.[5] A study by Ahrenholz has shown that irrigation with these solutions not only dilute bacterial mass, but also impair bacterial phagocytosis because of dilution of defensive proteins like opsonins.[6] Traditionally, sterile water, warm saline and povidone-iodine are most commonly used for the purpose of peritoneal lavage. Some researchers recommend the addition of antibiotics in these fluids for better results. Among various antibiotics, metronidazole has proved to be most beneficial in treating the peritonitis.[7-9] Metronidazole is an antibiotic and antiprotozoal drug. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, bacterial vaginosis, dracunculiasis, giardiasis, trichomoniasis and amoebiasis.[10] Despite the profound reduction in peritoneal bacterial counts the rate of post-operative sepsis, wound infection, intra-abdominal abscess and septicemia were extremely high. These results indicate that saline peritoneal lavage alone is no substitute for short-term antimicrobial prophylaxis. Still the literature regarding the advantage of using antibiotics along with sterile water for peritoneal lavage is lacking. Hence, this study is conducted to compare the effect of sterile warm water and antibiotics for the purpose of peritoneal lavage.

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