Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of IOPL in patients with IAIs. The databases of PubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, and CBM databases were searched from inception to December 31, 2022. Random-effects models were used to calculate the risk ratio (RR), mean difference, and standardized mean difference. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence. Ten RCTs with 1318 participants were included, of which eight studies on appendicitis and two studies on peritonitis. Moderate-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (0% vs. 1.1%; RR, 0.31 [95% CI, 0.02–6.39]), intra-abdominal abscess (12.3% vs. 11.8%; RR, 1.02 [95% CI, 0.70–1.48]; I2 = 24%), incisional surgical site infections (3.3% vs. 3.8%; RR, 0.72 [95% CI, 0.18–2.86]; I2 = 50%), postoperative complication (11.0% vs. 13.2%; RR, 0.74 [95% CI, 0.39–1.41]; I2 = 64%), reoperation (2.9% vs. 1.7%; RR,1.71 [95% CI, 0.74–3.93]; I2 = 0%) and readmission (5.2% vs. 6.6%; RR, 0.95 [95% CI, 0.48–1.87]; I2 = 7%) in patients with appendicitis when compared to non-IOPL. Low-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (22.7% vs. 23.3%; RR, 0.97 [95% CI, 0.45–2.09], I2 = 0%) and intra-abdominal abscess (5.1% vs. 5.0%; RR, 1.05 [95% CI, 0.16–6.98], I2 = 0%) in patients with peritonitis when compared to non-IOPL. IOPL with saline use in patients with appendicitis was not associated with significantly decreased risk of mortality, intra-abdominal abscess, incisional surgical site infection, postoperative complication, reoperation, and readmission compared with non-IOPL. These findings do not support the routine use of IOPL with saline in patients with appendicitis. The benefits of IOPL for IAI caused by other types of abdominal infections need to be investigated.

中文翻译：

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腹腔内感染患者术中生理盐水腹腔灌洗的有效性：系统评价和荟萃分析

用生理盐水进行术中腹腔灌洗 (IOPL) 已广泛用于外科手术。然而，IOPL 在腹内感染 (IAI) 患者中使用生理盐水的有效性仍存在争议。本研究旨在系统地回顾评估 IOPL 在 IAI 患者中有效性的随机对照试验 (RCT)。检索 PubMed、Embase、Web of Science、Cochrane library、CNKI、万方和 CBM 数据库从建站到 2022 年 12 月 31 日的数据库。使用随机效应模型计算风险比（RR）、均值差和标准化均值差。建议评估、制定和评价的分级 (GRADE) 用于对证据的质量进行评级。纳入了 10 项 RCT，共有 1318 名参与者，其中八项关于阑尾炎的研究和两项关于腹膜炎的研究。中等质量的证据表明，使用 IOPL 和生理盐水与降低死亡率（0% 对 1.1%；RR，0.31 [95% CI，0.02–6.39]）、腹腔内脓肿（12.3%与 11.8%；RR，1.02 [95% CI，0.70–1.48]；I2 = 24%），切口手术部位感染（3.3% 与 3.8%；RR，0.72 [95% CI，0.18–2.86]；I2 = 50%)，术后并发症（11.0% 对 13.2%；RR，0.74 [95% CI，0.39–1.41]；I2 = 64%），再次手术（2.9% 对 1.7%；RR，1.71 [95% CI] , 0.74–3.93]；I2 = 0%）和再入院率（5.2% 对 6.6%；RR，0.95 [95% CI，0.48–1.87]；I2 = 7%）与非 IOPL 相比，阑尾炎患者。低质量证据表明，使用 IOPL 和盐水与死亡率风险降低无关（22.7% 对 23.3%；RR，0.97 [95% CI，0.45–2.09]，与非 IOPL 相比，腹膜炎患者的 I2 = 0%）和腹腔内脓肿（5.1% 对 5.0%；RR，1.05 [95% CI，0.16–6.98]，I2 = 0%）。与非 IOPL 相比，阑尾炎患者使用盐水的 IOPL 与死亡率、腹腔内脓肿、切口手术部位感染、术后并发症、再次手术和再入院的风险显着降低无关。这些发现不支持在阑尾炎患者中常规使用 IOPL 和生理盐水。需要研究 IOPL 对其他类型腹部感染引起的 IAI 的益处。与非 IOPL 相比，阑尾炎患者使用盐水的 IOPL 与死亡率、腹腔内脓肿、切口手术部位感染、术后并发症、再次手术和再入院的风险显着降低无关。这些发现不支持在阑尾炎患者中常规使用 IOPL 和生理盐水。需要研究 IOPL 对其他类型腹部感染引起的 IAI 的益处。与非 IOPL 相比，阑尾炎患者使用盐水的 IOPL 与死亡率、腹腔内脓肿、切口手术部位感染、术后并发症、再次手术和再入院的风险显着降低无关。这些发现不支持在阑尾炎患者中常规使用 IOPL 和生理盐水。需要研究 IOPL 对其他类型腹部感染引起的 IAI 的益处。