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Postoperative adhesions between abdominal and pelvic organs remain a challenging issue in surgical practice, with severe cases potentially leading to complications such as intestinal obstruction, chronic pain, and infertility. The development of surgical techniques and the application of various anti adhesion products and methods have contributed to reducing the incidence of these complications to some extent. Postoperative peritoneal lavage, which involves the intermittent or continuous infusion and drainage of lavage solution via a catheter through the abdominal wall, serves to isolate abdominal organs and remove residual tissue, foreign matter, and inflammatory factors, ultimately reducing adhesion formation. This review discusses the role, advantages, and limitations of postoperative lavage in preventing abdominopelvic adhesions. [ABSTRACT FROM AUTHOR]

Abstract Background In septic arthritis, joint lavage can be performed using arthrocentesis (articular needle aspiration) or arthrotomy. The use of fluoroscopy to guide the puncture involves radiation. Ultrasound (US) guidance is still little recommended to guide the treatment of septic arthritis in children. We wanted to know whether treating septic arthritis in children was feasible and safe under ultrasound (US) guidance. Methods We retrospectively included 67 children (mean age, 3.0 years; range: 1 month–12 years) treated for septic arthritis of the hip, shoulder, or ankle using arthrocentesis or arthrotomy under US or fluoroscopic guidance (non-US group) with at least two years of follow-up. Results We found no significant difference between the groups. After arthrocentesis, patients in the US group remained in hospital for 0.8 days longer than those in the non-US group, but the difference was not significant. After arthrotomy, the arthrotomy-US group required 0.4 more days of hospitalization than the non-US group, but the difference was not significant. Patients in the US group exhibited higher initial CRP and WBC values than patients treated without US, although the differences were not significant. The WBC values of the arthrocentesis-US groups were higher than those of the non-US groups initially and at 72 h, but non significantly so; they became similar on day 5. Three puncture failures required arthrotomy (two under US guidance). Three patients required early revision surgery: one had undergone arthrocentesis with US, one arthrocentesis without US, and one arthrotomy without US. At the last follow-up, there were no clinical sequelae but two hip arthrotomies (one US and one non-US child) showed asymptomatic calcifications. Conclusions US guidance is feasible and safe for treating septic arthritis in children, visualizing structures not shown by X-rays and avoiding radiation exposure during surgery. Level of evidence IV (case series). Trial registration IRB-MTP_2021_05_202100781

Objective: To determine if knee arthroplasty without sonographically visible effusion needs to undergo lavage to rule out infection. Methods: Patients were accrued by a retrospective search of a longitudinally maintained radiology database looking for patients referred for ultrasound guided aspiration of suspected TKA infection. Clinical presentations, laboratory tests, intraoperative findings, and follow-up were reviewed. Results: Four hundred sixty-nine patients were included (mean age of 67 years (range, 36–91)) including 251 females. Four hundred three patients had effusions, of which 57 were infected based on ultrasound-guided and surgical aspirates. Sixty-four patients lacked effusions, of which 47 underwent lavage at the clinicians' request, with 6/47 infected. Nineteen patients without effusion were not lavaged at the clinicians' request due to low suspicion, and none were infected. Patients with positive lavage cultures all had clinical risk factors. Infection rates were significantly higher in patients with joint effusion and clinical suspicion for infection compared to absent joint effusion and absent clinical suspicion. A significantly higher proportion of patients with hyperemia or moderate-severe synovial thickening on ultrasound were symptomatic and had joint effusion and positive joint cultures. Aspiration of native fluid had 85% sensitivity and 100% specificity while lavage had a sensitivity of 57% and specificity of 100%. Negative predictive value for native aspirates was 94% compared to 86% for lavage. Conclusion: A TKA with low clinical suspicion of infection does not need to undergo lavage in the absence of a sonographically visible effusion. [ABSTRACT FROM AUTHOR]

Background: In septic arthritis, joint lavage can be performed using arthrocentesis (articular needle aspiration) or arthrotomy. The use of fluoroscopy to guide the puncture involves radiation. Ultrasound (US) guidance is still little recommended to guide the treatment of septic arthritis in children. We wanted to know whether treating septic arthritis in children was feasible and safe under ultrasound (US) guidance. Methods: We retrospectively included 67 children (mean age, 3.0 years; range: 1 month–12 years) treated for septic arthritis of the hip, shoulder, or ankle using arthrocentesis or arthrotomy under US or fluoroscopic guidance (non-US group) with at least two years of follow-up. Results: We found no significant difference between the groups. After arthrocentesis, patients in the US group remained in hospital for 0.8 days longer than those in the non-US group, but the difference was not significant. After arthrotomy, the arthrotomy-US group required 0.4 more days of hospitalization than the non-US group, but the difference was not significant. Patients in the US group exhibited higher initial CRP and WBC values than patients treated without US, although the differences were not significant. The WBC values of the arthrocentesis-US groups were higher than those of the non-US groups initially and at 72 h, but non significantly so; they became similar on day 5. Three puncture failures required arthrotomy (two under US guidance). Three patients required early revision surgery: one had undergone arthrocentesis with US, one arthrocentesis without US, and one arthrotomy without US. At the last follow-up, there were no clinical sequelae but two hip arthrotomies (one US and one non-US child) showed asymptomatic calcifications. Conclusions: US guidance is feasible and safe for treating septic arthritis in children, visualizing structures not shown by X-rays and avoiding radiation exposure during surgery. Level of evidence: IV (case series). Trial registration: IRB-MTP_2021_05_202100781 [ABSTRACT FROM AUTHOR]

Introduction: Resterilizable medical devices go through a washing process, where the temperature/duration pairing usually comply with an A0=3000 factor. In the context of energy tensions, we aimed to determine the most energy-efficient pairing. Method: We modeled the curve corresponding to the equation controlling the A0 = 3000 factor, then select the pairs to be measured, corresponding to the curve's inflection points. We installed a multimeter to measure the power consumption of our washer. Power consumption was computer-modeled, and the lowest point of the curve was determined. Results: The power consumption of our washer follows a polynomial curve of equation 32.043.x² - 5875.3.x + 276555 (R=0.993). The lowest point on the curve corresponds to the 92°/190s couple, with lower power consumption than the 93°/180 s couple currently used in service (p < 0.05). With over 1990 cycles per year and a cost reduction of almost 30%, the potential saving would be €915. Discussion: We were able to determine the most economical pairing in terms of power consumption on our washer. Further measurements are to be carried out on our other washers, to determine whether the results observed are also applicable to them. [ABSTRACT FROM AUTHOR]

Aim: To evaluate and synthesise the effectiveness of intra-operative gentamicin in reducing post-operative surgical site infections compared to other irrigating solutions or no irrigation. Background: Surgical site infection has posed challenges to health care providers around the globe. It is influenced by many risk factors, only a few of which are under the control of the surgeon and operating team. Wound irrigation is considered an essential part of the intra-operative process. It aims to minimise the risk of surgical site infection by thorough lavage of the operative site. Design: Systematic review of effectiveness. Review methods: The databases CINAHL, Scopus, Embase, Medline, PubMed, OpenGrey, Google Scholar and ProQuest Dissertations & Theses Global were searched with parameters set between 1 January 2013 and 31 July 2023. The review followed the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness and the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA 2020) guidelines. Two independent reviewers conducted the selection process, critical appraisal and data extraction. The eligible studies were critically appraised using JBI critical appraisal tools for randomised controlled trials and cohort studies. Data synthesis was performed through subgroup analysis and narrative synthesis, since meta-analysis was not possible. Results: The impact of intra-operative gentamicin irrigation on surgical site infections was analysed across eight studies. The subgroup analysis favoured the gentamicin saline group over the saline group in reducing post-operative surgical site infections (RR=0.27 [0.13;0.55], P < 0.001.) Conclusion: This systematic review shows that intra-operative gentamicin irrigation lowers the incidence of surgical site infections when compared to normal saline irrigation. However, there were contradictory results when intra-operative gentamicin irrigation was compared to alternative interventions such as no irrigation, diluted povidone iodine and combination antibiotic irrigation. [ABSTRACT FROM AUTHOR]

Abdominal tuberculosis (TB), an extrapulmonary manifestation of TB, can present with nonspecific symptoms that may resemble an acute surgical abdomen or abdominal malignancy. Peritoneal tuberculosis/TB peritonitis, typically manifests with abdominal pain, abdominal distension (possibly due to ascites), weight loss, and night sweats. We present two cases of peritoneal TB where patients exhibited abdominal distension and weight loss with features suggestive of intestinal obstruction or an abdominal malignancy. They were initially treated with standard anti-TB medication (RHZE regimen), but showed no improvement. However, after undergoing laparotomy and lavage, resulting in reduced focus of infection, they responded well to the 6-month course of anti-TB medication. The current management approach for abdominal TB recommends a 6-month regimen of anti-TB medication. Despite the lack of initial response to anti-TB medication, the substantial improvement observed when initiating anti-TB treatment after peritoneal lavage indicates its potential benefit in such patients. Further research is needed to explore this question.

Abdominal tuberculosis (TB), an extrapulmonary manifestation of TB, can present with nonspecific symptoms that may resemble an acute surgical abdomen or abdominal malignancy. Peritoneal tuberculosis/TB peritonitis, typically manifests with abdominal pain, abdominal distension (possibly due to ascites), weight loss, and night sweats. We present two cases of peritoneal TB where patients exhibited abdominal distension and weight loss with features suggestive of intestinal obstruction or an abdominal malignancy. They were initially treated with standard anti-TB medication (RHZE regimen), but showed no improvement. However, after undergoing laparotomy and lavage, resulting in reduced focus of infection, they responded well to the 6-month course of anti-TB medication. The current management approach for abdominal TB recommends a 6-month regimen of anti-TB medication. Despite the lack of initial response to anti-TB medication, the substantial improvement observed when initiating anti-TB treatment after peritoneal lavage indicates its potential benefit in such patients. Further research is needed to explore this question. [ABSTRACT FROM AUTHOR]

There is much controversy about the application of abdominal irrigation in the prevention of wound infection (WI) and intra‐abdominal abscess (IAA) in the postoperative period. Therefore, we performed a meta‐analysis of the effect of suctioning and lavage on appendectomy to assess the efficacy of either suctioning or lavage. Data were collected and estimated with RevMan 5.3 software. Based on our research, we found 563 publications in our database, and we eventually chose seven of them to analyse. The main results were IAA after the operation and WI. Inclusion criteria were clinical trials of an appendectomy with suctioning or lavage. In the end, seven trials were chosen to meet the eligibility criteria, and the majority were retrospective. The results of seven studies showed that there was no statistically significant difference between abdominal lavage and suctioning treatment for post‐operative WI (OR, 1.82; 95% CI, 0.40, 2.61; p = 0.96); There was no statistically significant difference between the two groups in the risk of postoperative abdominal abscess after operation (OR, 1.16; 95% CI, 0.71, 1.89; p = 0.56). No evidence has been found that the use of abdominal lavage in the treatment of postoperative infectious complications after appendectomy is superior to aspiration. [ABSTRACT FROM AUTHOR]

Purpose: Neuro-endoscopic lavage (NEL) is an increasingly popular intervention for intraventricular haemorrhage (IVH) and post-haemorrhagic hydrocephalus (PHH), with considerable variation in technique dependent on clinician and clinical circumstances. Whilst efforts to standardise the technique are ongoing, this work describes a tertiary centre experience utilising NEL, highlighting potential caveats to standardisation. Methods: A retrospective review of electronic case notes for patients undergoing temporising surgical intervention for IVH between 2012 and 2021 at our centre was performed. Data collected included (i) gestational age, (ii) aetiology of hydrocephalus, (iii) age at time of intervention, (iv) intervention performed, (v) need for permanent CSF diversion, (vi) 'surgical burden', i.e. number of procedures following primary intervention, and (vii) wound failure and infection rate. Data was handled in Microsoft Excel and statistical analysis SPSS v27.0 Results: 49 neonates (n = 25 males) were included. Overall mean gestational age was 27 weeks and at intervention 35 + 3 weeks. IVH was the predominant cause of hydrocephalus (93.8%) and primary surgical interventions included insertion of a ventriculosubgaleal shunt (VSGS) in n = 41 (83.6%) patients, NEL in n = 6 (12.2%) patients and insertion of an EVD in n = 2 (4.1%). N = 9 (18.4%) patients underwent NEL at some point during the time interval reviewed; n = 4 (8.2%) received NEL monotherapy and n = 5 (10.2%) also received a VSGS. Rate of conversion to definitive CSF diversion between NEL (n = 8, 88.9%) and VSGS cohorts (n = 37, 92.5%) was not significantly different (p = 0.57), nor between NEL alone (n = 3, 75%) and NEL + VSGS (n = 5, 100%) (p = 0.44). None of the patients that underwent NEL monotherapy had any wound issues or CNS infection as a result of the initial intervention, compared to n = 3 (60%) of those that underwent NEL and implantation of VSGS (p = 0.1). Conclusion: Both NEL and VSGS are effective in temporising hydrocephalus in neonates, occasionally offering a definitive solution in and of themselves. The benefit of dual therapy however remains to be seen, with the addition of VSGS potentially increasing the risk of wound failure in an already vulnerable cohort. [ABSTRACT FROM AUTHOR]

PURPOSE: Intraoperative wound irrigation prior to closure during total joint arthroplasty (TJA) is an essential component of preventing infections and limiting health care system costs. While studies have shown the efficacy of dilute betadine in reducing infection risk, there remains concerns over its safety profile and theoretical inactivation by blood and serum. This study aims to compare infection and wound complications between chlorhexidine gluconate (CHG) and betadine lavage during TJA. METHODS: All primary TJA between 2019-2021 were analyzed at a single institution, and periprosthetic joint infection (PJI), wound drainage, 30 and 90-day emergency room (ER) readmission due to wound complications, aseptic loosening, and revision surgery rate were compared between patients undergoing intraoperative CHG versus betadine lavage prior to closure. Baseline demographics were controlled, and multivariate logistic regression was performed to compare complication rates. RESULTS: A total of 410 TJA, including 160 hip and 250 knee arthroplasties were included. Compared to the dilute betadine cohort, all TJA patients undergoing CHG lavage had a statistically significant lower 30 and 90-day emergency room readmission rate due to wound complications. Both hip and knee arthroplasty patients with CHG had a statistically significant lower rate of postoperative superficial drainage and dressing saturation at clinic follow-up, but only knee arthroplasty patients had significant decreased readmission rate for incisional wound vacuum placement and close inpatient monitoring of wound healing. Among all TJA, there was no significant association in the rate of PJI requiring return to the OR between groups. CONCLUSIONS: Although betadine is cost-effective and has been shown to reduce PJI rates, there remains concerns in the literature over soft tissue toxicity and wound healing. This study suggests CHG may be as efficacious as dilute betadine in preventing PJI while also decreasing the risk of superficial drainage and wound complications needing unplanned ER visits during the acute postoperative period.

Abstract Background This study aims to investigate the outcomes of patients who received early fiberoptic bronchoscopic sputum aspiration and lavage after thoracoscopic and laparoscopic esophagectomy due to esophageal cancer. Methods A prospective randomized clinical trial was performed between March 2020 and June 2022. Patients who were scheduled for thoracoscopic and laparoscopic esophagectomy due to esophageal cancer were enrolled. Then, these patients were assigned to the control group (traditional postoperative care) and study group (traditional postoperative care with early bronchoscopic sputum aspiration and lavage). The outcomes, which included the length of hospital stay and medical expenses, and postoperative complications, which included pulmonary infection, atelectasis, respiratory dysfunction and anastomotic leakage, were compared between these two groups. Results A total of 106 patients were enrolled for the present study, and 53 patients were assigned for the control and study groups. There were no statistically significant differences in gender, age, and location of the esophageal cancer between the two groups. Furthermore, the length of hospital stay was statistically significantly shorter and the medical expenses were lower during hospitalization in the study group, when compared to the control group (12.3 ± 1.2 vs. 18.8 ± 1.3 days, 5.5 ± 0.9 vs. 7.2 ± 1.2 Chinese Yuan, respectively; all, P

Introduction Multiple solutions are currently used to cleanse a deep neck infection (DNI), and a variety of devices are available to deliver wound irrigation solutions. An essential difference between these devices is the pressure that the irrigation solution exerts over the wound tissue. Objective To compare low-pressure and high-pressure irrigation delivery systems for wound cleansing in DNI. Methods we designed a retrospective cohort study and reviewed the medical records of patients operated on due to DNI from June 2016 to December 2017 at our institution. One cohort included patients treated with an intraoperative irrigation method that exerts low pressure over the irrigated tissue, and the other cohort, to a system capable of generating higher pressure. The Pearson Chi-squared test was used to analyze the data. Results A total of 42 patients whose ages ranged from 16 months to 72 years were included. The low-pressure irrigation system was used in 18 patients, and the high-pressure system was used in 24 patients. No statistical differences were observed regarding the irrigation methods, the complexity of the DNI, and the overall outcomes. Conclusions The present is the first study in which low- and high-pressure systems for wound lavage were evaluated in the treatment of DNI. When comparing these methods, we did not find one to be superior to the other; however, the additional cost associated with the high-pressure devices may not justify their in head and neck procedures. [ABSTRACT FROM AUTHOR]