Impact of large amount of intra‐abdominal lavage on surveillance of surgical site infection after hepato‐pancreato‐biliary surgery: A prospective cohort study

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Abstract
Background/Purpose: In hepatobiliary and pancreatic (HBP) surgery, the role and significance of intra‐abdominal lavage (IAL) for surgical site infection (SSI) is controversial.Methods: This prospective study was performed between July 2020 and July 2022. A total of 150 patients, 10‐L IAL was performed. The lavage fluid at 1‐L, 5‐L, and 10‐L was subjected to bacterial culture examination. Risk factors for SSI were evaluated.Results: Bacterial positivity rate significantly decreased as follows: 1‐L, 36% (n = 54); 5‐L, 27% (n = 41); 10‐L, 23% (n = 35) (36% vs 23%, p = .001). Patients with positive lavage fluid culture at 10‐L had significantly higher incidence of both incisional (37% vs 6%, p < .01) and organ/space (54% vs 3%, p < .01) SSI. Multivariate analysis revealed positivity for bacterial culture at 10‐L as the strongest independent risk factor for incisional SSI (OR 13.0, 95% CI: 3.86–43.6, p < .01), followed by postoperative pancreatic fistula (OR 11.7, 95% CI: 3.03–45.6, p < .01). Likewise, in organ/space SSI, positivity for bacterial culture at 10‐L was the strongest independent risk factor (OR 48.9, 95% CI:12.1–197.7, p < .01), followed by digestive reconstruction (OR 5.20, 95% CI: 1.45–18.6, p = .01).Conclusion: IAL decreased the intraperitoneal contamination rate in a volume‐dependent manner and can be useful in the surveillance of SSI development in HBP surgery.

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