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Advances in Surgery Sep 2018
Comparative Study Review
Topics: Diverticulitis, Colonic; Female; Follow-Up Studies; Humans; Laparoscopy; Male; Minimally Invasive Surgical Procedures; Peritoneal Lavage; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30098618
DOI: 10.1016/j.yasu.2018.03.004 -
The Journal of Trauma and Acute Care... Mar 2024
Topics: Humans; Peritoneal Lavage; Peritoneum; Abdominal Injuries
PubMed: 37972941
DOI: 10.1097/TA.0000000000004211 -
Revista Do Colegio Brasileiro de... 2020to assess whether laparoscopy with peritoneal lavage is superior to computed tomography for staging gastric adenocarcinoma and whether it can modify the surgical... (Comparative Study)
Comparative Study
OBJECTIVE
to assess whether laparoscopy with peritoneal lavage is superior to computed tomography for staging gastric adenocarcinoma and whether it can modify the surgical approach.
METHODS
we conducted a retrospective study of 46 patients with gastric adenocarcinoma treated by the digestive surgery team of the Passo Fundo Clinics Hospital (RS), from January 2015 to December 2018, and submitted to laparoscopy with preoperative peritoneal lavage. All patients underwent preoperative clinical staging with computed tomography.
RESULTS
of the 46 patients analyzed, the majority had tumors located in the cardia (34.8%), poorly differentiated (69.6%), and subtype signet ring cells (65.2%). In 91.3%, the computed tomography scan did not identify peritoneal carcinomatosis or distant metastasis. Among these patients with negative computed tomography for distant disease, 21.8% had positive peritoneal lavage for neoplastic cells and had their therapeutic approaches modified.
CONCLUSION
laparoscopy and peritoneal lavage altered the surgical decision in 21.8% of patients, providing a more reliable preoperative staging in gastric adenocarcinoma.
Topics: Adenocarcinoma; Aged; Digestive System Surgical Procedures; Female; Gastrectomy; Humans; Laparoscopy; Male; Middle Aged; Neoplasm Staging; Peritoneal Lavage; Preoperative Care; Retrospective Studies; Stomach Neoplasms; Tomography, X-Ray Computed
PubMed: 32022110
DOI: 10.1590/0100-6991e-20192314 -
The Journal of Trauma and Acute Care... Dec 2017Mitochondrial damage-associated molecular patterns (mtDAMPs), such as mitochondrial DNA and N-formylated peptides, are endogenous molecules released from tissue after... (Observational Study)
Observational Study
BACKGROUND
Mitochondrial damage-associated molecular patterns (mtDAMPs), such as mitochondrial DNA and N-formylated peptides, are endogenous molecules released from tissue after traumatic injury. mtDAMPs are potent activators of the innate immune system. They have similarities with bacteria, which allow mtDAMPs to interact with the same pattern recognition receptors and mediate the development of systemic inflammatory response syndrome (SIRS). Current recommendations for management of an open abdomen include returning to the operating room every 48 hours for peritoneal cavity lavage until definitive procedure. These patients are often critically ill and develop SIRS. We hypothesized that mitochondrial DAMPs are present in the peritoneal cavity fluid in this setting, and that they accumulate in the interval between washouts.
METHODS
We conducted a prospective pilot study of critically ill adult patients undergoing open abdomen management in the surgical and trauma intensive care units. Peritoneal fluid was collected daily from 10 open abdomen patients. Specimens were analyzed via quantitative polymerase chain reaction (qPCR) for mitochondrial DNA (mtDNA), via enzyme immunoassay for DNAse activity and via Western blot analysis for the ND6 subunit of the NADH: ubiquinone oxidoreductase, an N-formylated peptide.
RESULTS
We observed a reduction in the expression of ND6 the day after lavage of the peritoneal cavity, that was statistically different from the days with no lavage (% change in ND6 expression, postoperative from washout: -50 ± 11 vs. no washout day, 42 ± 9; p < 0.05). Contrary to expectation, the mtDNA levels remained relatively constant from sample to sample. We then hypothesized that DNAse present in the effluent may be degrading mtDNA.
CONCLUSION
These results indicate that the peritoneal cavity irrigation reduces the presence of mitochondrial DAMPs in the open abdomen. It is possible that increased frequency of peritoneal cavity lavage may lead to decreased systemic absorption of mtDAMPs, thereby reducing the risk of SIRS.
LEVEL OF EVIDENCE
Prospective study, Case Series, Level V.
Topics: Abdominal Injuries; Adult; DNA, Mitochondrial; Female; Humans; Male; Mitochondria; Mitophagy; Peritoneal Lavage; Pilot Projects; Prospective Studies
PubMed: 28806285
DOI: 10.1097/TA.0000000000001676 -
The Journal of Trauma Mar 2007Assessment of patients in the emergency department who sustain blunt abdominal trauma represents a significant diagnostic challenge. Computed tomography (CT) is... (Meta-Analysis)
Meta-Analysis Review
Are diagnostic peritoneal lavage or focused abdominal sonography for trauma safe screening investigations for hemodynamically stable patients after blunt abdominal trauma? A review of the literature.
BACKGROUND
Assessment of patients in the emergency department who sustain blunt abdominal trauma represents a significant diagnostic challenge. Computed tomography (CT) is increasingly used as the principal investigation for these patients. A sensitive screening test could safely reduce the use of CT.
OBJECTIVES
To appraise the evidence supporting the use of diagnostic peritoneal lavage and focused abdominal sonography for trauma as screening tests in the emergency department to reduce the use of CT in the initial assessment of patients sustaining blunt abdominal trauma.
METHODS
A search of high-quality evidence resources was performed, followed by a hand search of the bibliographies of all relevant articles.
RESULTS
Altogether, 55 articles were found during the initial search, of which 23 were relevant. An additional 11 were found by hand searching. Six relevant original research articles were found.
CONCLUSION
Screening diagnostic peritoneal lavage and selective CT is a safe diagnostic strategy for the investigation of blunt abdominal trauma. Further research is needed to determine the role of focused abdominal sonography for trauma scanning in diagnostic protocols.
Topics: Abdomen; Abdominal Injuries; Humans; Peritoneal Lavage; Radiography, Abdominal; Tomography, X-Ray Computed; Ultrasonography; Wounds, Nonpenetrating
PubMed: 17414368
DOI: 10.1097/01.ta.0000250493.58701.ad -
Journal of Veterinary Emergency and... Nov 2019To evaluate bacterial isolates, antimicrobial drug susceptibility, and change in resistance among pre- and post-lavage culture samples in dogs with septic peritonitis.
OBJECTIVE
To evaluate bacterial isolates, antimicrobial drug susceptibility, and change in resistance among pre- and post-lavage culture samples in dogs with septic peritonitis.
DESIGN
Prospective observational study.
SETTING
Private practice referral hospital.
ANIMALS
Forty client-owned dogs with confirmed septic peritonitis requiring surgical intervention.
INTERVENTIONS
All dogs had perioperative abdominal lavage following source control with 200 to 300 mL/kg 0.9% sterile saline. Pre- and post-lavage aerobic and anaerobic culture samples were evaluated.
MEASUREMENTS AND MAIN RESULTS
Thirty-five of 40 dogs (87.5%) survived to hospital discharge. The likelihood of an aerobic organism to have multidrug resistance (resistance to 3 or more antimicrobial classes) post-lavage was a third of that pre-lavage (odds ratio [OR] 0.34, 95% CI [0.17-0.68], P = 0.01). Thirty-nine of 40 dogs (97.5%) received appropriate empiric antimicrobial therapy based on pre- and post-lavage culture results, of which 5 (12.8%) did not survive to discharge. The single dog with inappropriate antimicrobial therapy survived to discharge. The most frequent isolates detected included Escherichia coli, Clostridium perfringens, and Enterococcus faecalis. The same organism based on species was isolated in pre- and post-lavage cultures in 32 dogs, accounting for 59 anaerobic and aerobic isolates. There was a new bacterial isolate detected in 20 dogs, accounting for 46 isolates and an overall total decrease of 14 isolates between pre- and post-lavage culture (P = 0.09).
CONCLUSIONS
This study suggests that there is a significant decrease in the likelihood of isolating a multidrug resistant organism following peritoneal lavage, and aerobic and anaerobic culture results have the potential to change following peritoneal lavage, although this cannot be confirmed without further studies. Overall survival rates were higher than previously reported in the literature for septic peritonitis.
Topics: Animals; Anti-Bacterial Agents; Bacteria; Dog Diseases; Dogs; Female; Microbial Sensitivity Tests; Peritoneal Lavage; Peritonitis; Prospective Studies
PubMed: 31637851
DOI: 10.1111/vec.12893 -
Journal of Hepato-biliary-pancreatic... Jun 2015Although intraoperative peritoneal lavage is often performed routinely with the aim of reducing peritoneal contamination, little evidence of lavage benefits in elective... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Although intraoperative peritoneal lavage is often performed routinely with the aim of reducing peritoneal contamination, little evidence of lavage benefits in elective liver resection without bile duct resection is available. We addressed the issue with a randomized clinical trial.
METHODS
We prospectively and randomly assigned consecutive patients undergoing liver resection to a lavage group or a non-lavage group. Peritoneal lavage was performed at the end of operation for patients in the lavage group. The primary endpoint was the rate of surgical site infection.
RESULTS
Ninety-six patients were assigned to the lavage group and 97 to the non-lavage group. When superficial/deep incisional infection and organ/space infection were considered together, no significant difference in surgical site infection rate was evident between lavage (21.9%) and non-lavage groups (13.4%, P = 0.135). However, organ/space infection was significantly more frequent in the lavage group (16.7%) than the non-lavage group (7.2%, P = 0.048). Peritoneal lavage was identified as a risk factor for organ/space infection by multivariate analysis (relative risk, 2.977; confidence interval, 1.094 to 8.100; P = 0.033).
CONCLUSION
Intraoperative peritoneal lavage does not reduce overall incidence of surgical site infection and may increase risk of organ/space infection.
Topics: Adult; Aged; Aged, 80 and over; Elective Surgical Procedures; Female; Follow-Up Studies; Hepatectomy; Humans; Incidence; Japan; Male; Middle Aged; Peritoneal Lavage; Prospective Studies; Surgical Wound Infection; Young Adult
PubMed: 25611190
DOI: 10.1002/jhbp.222 -
Advanced Science (Weinheim,... Jul 2023Peritoneal metastasis (PM) is the mostcommon form of distant metastasis and one of the leading causes of death in gastriccancer (GC). For locally advanced GC, clinical...
Peritoneal metastasis (PM) is the mostcommon form of distant metastasis and one of the leading causes of death in gastriccancer (GC). For locally advanced GC, clinical guidelines recommend peritoneal lavage cytology for intraoperative PM detection. Unfortunately, current peritoneal lavage cytology is limited by low sensitivity (<60%). Here the authors established the stimulated Raman molecular cytology (SRMC), a chemical microscopy-based intelligent cytology. The authors firstly imaged 53 951 exfoliated cells in ascites obtained from 80 GC patients (27 PM positive, 53 PM negative). Then, the authors revealed 12 single cell features of morphology and composition that are significantly different between PM positive and negative specimens, including cellular area, lipid protein ratio, etc. Importantly, the authors developed a single cell phenotyping algorithm to further transform the above raw features to feature matrix. Such matrix is crucial to identify the significant marker cell cluster, the divergence of which is finally used to differentiate the PM positive and negative. Compared with histopathology, the gold standard of PM detection, their SRMC method could reach 81.5% sensitivity, 84.9% specificity, and the AUC of 0.85, within 20 minutes for each patient. Together, their SRMC method shows great potential for accurate and rapid detection of PM from GC.
Topics: Humans; Peritoneal Neoplasms; Stomach Neoplasms; Peritoneal Lavage; Microscopy; Artificial Intelligence
PubMed: 37114845
DOI: 10.1002/advs.202300961 -
Internal Medicine (Tokyo, Japan) 2014To improve the prognosis of severe acute pancreatitis, preventing infectious complications, particularly infected pancreatic necrosis, is important. The present study...
OBJECTIVE
To improve the prognosis of severe acute pancreatitis, preventing infectious complications, particularly infected pancreatic necrosis, is important. The present study evaluated the efficacy of peritoneal lavage for improving the prognosis of patients with severe acute pancreatitis.
PATIENTS
We retrospectively reviewed the cases of 23 consecutive patients with severe acute pancreatitis who were treated with peritoneal lavage.
RESULTS
Peritoneal lavage was started within 72 hours after the initial onset of symptoms in 20 patients (87%). The duration of peritoneal lavage, which was significantly correlated with the number of prognostic factors according to the revised Japanese criteria, Ranson score and serum C-reactive protein level at the start of peritoneal lavage, was a median of seven (3-22) days. There were no adverse events associated with the peritoneal lavage. Eight patients (35%) concurrently underwent continuous regional arterial infusion. Five days after starting peritoneal lavage, the patients' clinical conditions significantly improved. Overall, the survival rate was 96%. One patient (4%) died due to rupture of a pseudoaneurysm of the splenic artery. Complications occurred in seven patients (30%). Infectious complications were observed in three patients (13%) (one patient developed infected pancreatic necrosis and bacteremia, and two patients developed bacteremia). Pseudocysts and pancreatic fistulas developed in five and one patient, respectively. The incidence of complications was lower in the patients receiving peritoneal lavage within 72 hours from the initial onset of symptoms than in the remaining patients (20% vs. 100%; p=0.005).
CONCLUSION
We speculate that peritoneal lavage reduces the mortality and incidence of complications in patients with severe acute pancreatitis.
Topics: Early Medical Intervention; Female; Humans; Male; Pancreatitis; Peritoneal Lavage; Retrospective Studies; Severity of Illness Index; Treatment Outcome
PubMed: 24390520
DOI: 10.2169/internalmedicine.53.0745 -
American Journal of Surgery Feb 1988The study was aimed at determining the value of peritoneal lavage as an aid in the diagnosis of acute peritonitis when the diagnosis could not be made by ordinary...
The study was aimed at determining the value of peritoneal lavage as an aid in the diagnosis of acute peritonitis when the diagnosis could not be made by ordinary clinical criteria. Thirty patients were studied prospectively. Twenty-five of the patients were suspected of having peritonitis but doubt existed because of an unreliable history or equivocal or confusing abdominal signs. Five remaining patients were comatose and an intraabdominal source of sepsis needed to be excluded. The technique of lavage and criteria for diagnosis have been presented herein. There were 10 true-positive results, no false-positive results, 19 true-negative results, and one false-negative result (positive predictive value 100 percent, confidence level 95 percent). There were no complications due to the test. Peritoneal lavage is a useful method of diagnosing or excluding peritonitis in patients with confusing abdominal signs. Negative results of laparotomy or prolonged observation may thus be obviated in such patients.
Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Peritoneal Lavage; Peritonitis; Prospective Studies
PubMed: 3341561
DOI: 10.1016/s0002-9610(88)80732-3