Effect of Pulsed Lavage on Surgical Site Infection in Abdominal Surgery: A Systematic Review and Meta-Analysis

Objective: To evaluate the effect of pulsed lavage on the risk of surgical site infection in patients undergoing abdominal. Methods: A systematic review and meta-analysis was conducted in compliance with PRISMA statement standards. We evaluated all studies comparing pulsed lavage and standard practice in patients undergoing abdominal surgery. Surgical site infection was the outcome measure. Random-effects modeling was applied for the analyses. The certainty of the evidence was assessed using the grade system. Results: Five studies including 747 patients were included. The operations in both groups were comparable in terms of elective (RD: 0.00, 95% CI -0.02-0.03, P = 0.85) or emergency setting (RD: -0.00, 95% CI -0.03-0.02, P = 0.85) and open (RD: 0.00, 95% CI -0.02-0.02, P = 0.94) or laparoscopic approach (RD: -0.00, 95% CI -0.02-0.02, P = 0.94). Pulsed lavage was associated with a reduced risk of surgical site infection compared with no pulsed lavage (OR: 0.31, 95% CI 0.20-0.48, P < 0.00001). The between-study heterogeneity was low (I2 = 0%), and the grade certainty was high. The results were consistent through subgroup analysis of randomized controlled trials (OR: 0.28, 95% CI 0.15-0.52, P < 0.0001), observational studies (OR: 0.35, 95% CI 0.19-0.64, P = 0.0007), patients undergoing elective operation (OR: 0.31, 95% CI 0.16-0.62, P = 0.0009), emergency operation (OR: 0.28, 95% CI 0.14-0.58, P = 0.0006), and open operation (OR: 0.30, 95% CI 0.16-0.55, P = 0.0001). Conclusions: Robust evidence suggests that pulsed lavage reduces the risk of surgical site infection in patients undergoing abdominal surgery. We do not hesitate to recommend the routine use of pulsed lavage in abdominal surgery in both emergency and elective settings.