A Comprehensive Systematic Review of Intraoperative Wound Irrigation for The Prevention of Surgical Site Infection after Laparotomy
Keywords:
Intraoperative wound irrigation, surgical site infection, laparotomy, antiseptic irrigation, antibiotic irrigation, pulse lavage, systematic reviewAbstract
Introduction: Surgical site infections (SSIs) remain a significant complication following laparotomy, leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. Intraoperative wound irrigation (IOWI) has been proposed as a preventive measure, but the optimal solution and technique remain debated.
Methods: This systematic review analyzed 40 sources, including randomized controlled trials, meta-analyses, and systematic reviews, retrieved via PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library. Studies were screened based on population (adult laparotomy patients), intervention (IOWI), outcome (SSI incidence), and design (RCTs, meta-analyses). Data extraction was performed using a large language model to capture intervention details, surgical context, SSI definitions, outcomes, and effect measures.
Results: IOWI significantly reduces SSI rates compared to no irrigation (RR 0.52, 95% CI 0.37–0.74). Antiseptic solutions, particularly povidone-iodine and polyhexanide, may offer additional benefit over saline in certain contexts, though evidence is heterogeneous. Antibiotic irrigation shows strong benefits in contaminated wounds and colorectal surgery. Pulse lavage is superior to standard pouring, while excessive irrigation volume may be counterproductive.
Discussion: The efficacy of IOWI is highly context-dependent, influenced by surgical type, contamination level, irrigation technique, and study quality. Antiseptic and antibiotic irrigations are most beneficial in high-risk settings, whereas saline irrigation remains effective in clean-contaminated cases.
Conclusion: Routine IOWI before skin closure is recommended for laparotomy patients. Antiseptic or antibiotic solutions should be considered in contaminated or colorectal surgery, and pulse lavage may enhance effectiveness. Future research should standardize protocols and focus on high-risk populations.
References
A. Adeleke, F. Wuraola, and O. Olasehinde. “Effect of Wound Irrigation with Povidone Iodine Versus Normal Saline on Superficial Incisional Surgical Site Infection Following Laparotomy for Peritonitis.” Journal of the West African College of Surgeons, 2024.
A. Quiroga-Garza, J. M. Valdivia-Balderas, Miguel Ángel Trejo-Sánchez, A. Espinosa-Uribe, C. G. Reyes-Hernández, and R. Elizondo-Omaña. “A Prospective, Randomized, Controlled Clinical Trial to Assess Use of 2% Lidocaine Irrigation to Prevent Abdominal Surgical Site Infection.” Ostomy/Wound Management, 2017.
A. Shah, N. A. Sasoli, and Farrukh Sami. “Compare the Incidence of Surgical Site Infection After Appendectomy Wound Irrigation with Normal Saline and Imipenem Solutions.” Pakistan Journal of Medical & Health Sciences, 2021.
A. Zeb, Muhammad Shoaib Khan, A. Iqbal, A. Khan, I. Ali, and Munir Ahmad. “Compare the Frequency of Surgical Site Infections Following Irrigation of Appendectomy Wounds with Sterile Saline Solution Vs Imipenem Solution.” Pakistan Journal of Medical & Health Sciences, 2023.
Abdul Malik Magsi, Muhammad S. Shafique, P. Sains, M. Baig, K. Singh, and M. Sajid. “SP1.8 Comparing the Efficacy of Povidone-Iodine Versus Normal Saline in Laparotomy Wound Irrigation to Prevent Surgical Site Infections: A Meta-Analysis.” British Journal of Surgery, 2023.
Ahmed F. Ghanem, Mustafa Abou-Ali, A. Hussein, A. Anwar, and Sameh T. Abu-Elela. “Evaluation of the Outcome of the Use of 2% Lidocaine Irrigation in the Prevention of Abdominal Surgical Site Infection,” 2021.
Alaa Abd Elsisy, Mahmoud G. Hagag, and Marwan Ewida. “The Effect of Peritoneal Lavage with a Mixture of Lincomycin–Gentamicin on Postoperative Infection in Cases of Colorectal Cancer Surgery,” 2017.
B. Shrestha, K. Yadav, Niravkumar Valjibhai Buha, Suman Dahal, Pratibha Yadav, and Prof Yadav. “Comparison of Gentamicin Saline Solution and Normal Saline in Reducing Surgical Site Infections in Open Appendectomy: A Randomized Controlled Trial.” Health Science Reports, 2025.
C. Swaminathan, Wei H. Toh, Ahmed Mohamed, Hussameldin M Nour, Mirza K Baig, and Muhammad S Sajid. “Comparing the Efficacy of Povidone-Iodine Versus Normal Saline in Laparotomy Wound Irrigation to Prevent Surgical Site Infections: A Meta-Analysis.” Cureus, 2023.
David K. Levin, Catherine Gorchels, and Roger Andersen. “Reduction of Post-Cesarean Section Infectious Morbidity by Means of Antibiotic Irrigation.” American Journal of Obstetrics and Gynecology, 1983.
Dr N. H. Wankhade, Dr R. L. Bhosale, and D. H. Tanwar. “Surgical Site Infection and Role of Intraoperative Wound Irrigation with Antibiotics.” 2022.
E. Magann, M. Dodson, Mark A. Lray, Robert L. Harris, J. Martin, and J. Morrison. “Preoperative Skin Preparation and Intraoperative Pelvic Irrigation: Impact on Post- Cesarean Endometritis and Wound Infection.” Obstetrics and Gynecology, 1993.
H. A. Pitt, Russell G. Postier, Thomas R. Gadacz, and John L. Cameron. “The Role of Topical Antibiotics in "High-Risk" Biliary Surgery.” Surgery, 1982.
Hassan Mashbari, Mohannad Hemdi, K. L. Chow, J. Doherty, G. Merlotti, S. Salzman, and Eduardo Smith Singares. “A Randomized Controlled Trial on Intra-Abdominal Irrigation During Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift.” Bulletin of Emergency and Trauma, 2018.
J. Ruiz-Tovar, Jair Santos, A. Arroyo, C. Llavero, Laura Armañanzas, A. López-Delgado, A. Frangi, M. Alcaide, F. Candela, and R. Calpena. “Effect of Peritoneal Lavage with Clindamycin-Gentamicin Solution on Infections After Elective Colorectal Cancer Surgery.” Journal of the American College of Surgeons, 2012.
Lin-yong Zhao, Weihan Zhang, Kai Liu, Xiao-Long Chen, Kun Yang, Xin-Zu Chen, and Jian-kun Hu. “Comparing the Efficacy of Povidone-Iodine and Normal Saline in Incisional Wound Irrigation to Prevent Superficial Surgical Site Infection: A Randomized Clinical Trial in Gastric Surgery.” Journal of Hospital Infection, 2022.
M. Nikfarjam, L. Weinberg, M. Fink, V. Muralidharan, G. Starkey, Robert Jones, K. Staveley-O’Carroll, and C. Christophi. “Pressurized Pulse Irrigation with Saline Reduces Surgical-Site Infections Following Major Hepatobiliary and Pancreatic Surgery: Randomized Controlled Trial.” World Journal of Surgery, 2014.
Mayank Singh, R. Agarwal, and Rahul Singh. “A Prospective Study on Pattern of Superficial Surgical Site Infections in Patients Undergoing Emergency Laparotomy for Perforation Peritonitis,” 2020.
Mehak Chauhan, Indrajit Parmar, and Pranay Khobaragade. “COMPARATIVE STUDY OF INTRAPERITONEAL INSTILLATION OF NORMAL 1.25% POVIDONE-IODINE AND SUPER-OXIDIZED SOLUTION IN PATIENTS WITH CONTAMINATED AND DIRTY ABDOMINAL SURGERIES,” 2023.
Mohammed Dhari Jumaah, Mahmood Hasen Shuhata, Daniah Majid Al-Hamndawee, Ibrahim Issam Al-Ani, and Ahmed Mohammed Al-Hadeethi. “Role of Intraoperative Antibiotics Wound Irrigation in Reducing Surgical Site Infection Following Open Appendectomy: A Randomized Controlled Trial.” BMC Surgery, 2025.
Muhammad Iqbal, Masood Jawaid, M. A. Qureshi, and S. Iqbal. “EFFECT OF POVIDONE- IODINE IRRIGATION ON POST APPENDECTOMY WOUND INFECTION: RANDOMIZED CONTROL TRIAL,” 2015.
R. Gill, D. P. Al-Adra, S. Campbell, David W. Olson, and B. Rowe. “Povidone-Iodine Irrigation of Subcutaneous Tissues May Decrease Surgical Site Infections in Elective Colorectal Operations: A Systematic Review.” Gastroenterology Research, 2011.
R. Jafari, M. Najafian, and Soghra Aria Zangeneh. “EFFECT OF GENTAMICIN TO PREVENT OF INFECTION IN SURGICAL SITE; A RANDOMIZED CLINICAL TRAI (RCT),” 2015.
R. M. Strobel, Marja Leonhardt, A. Krochmann, K. Neumann, F. Speichinger, L. Hartmann, Lucas D Lee, et al. “Reduction of Postoperative Wound Infections by Antiseptica (RECIPE)?: A Randomized Controlled Trial.” Annals of Surgery, 2020.
R. M. Strobel, Marja Leonhardt, F. Förster, K. Neumann, L. Lobbes, C. Seifarth, Lucas D Lee, et al. “The Impact of Surgical Site Infection—a Cost Analysis.” Langenbeck's Archives of Surgery (Print), 2021.
Rizwanullah Junaid Bhanbhro, K. Almani, S. Kazi, Navaid Kazi, and S. Kazi. “To Evaluate Povidone-Iodine Effect On Post Appendectomy Surgical Site Infection.” Journal of Bahria University Medical and Dental College, 2018.
Ryo Maemoto, H. Noda, Kosuke Ichida, Sawako Tamaki, Rina Kanemitsu, Erika Machida, Nozomi Kikuchi, et al. “Superiority Trial Comparing Intraoperative Wound Irrigation with Aqueous 10% Povidone–Iodine to Saline for the Purpose of Reducing Surgical Site Infection After Elective Gastrointestinal Surgery: Study Protocol for a Randomised Controlled Trial.” BMJ Open, 2021.
Ryo Maemoto, H. Noda, Kosuke Ichida, Y. Miyakura, Nao Kakizawa, Erika Machida, H. Aizawa, et al. “Aqueous Povidone-Iodine Versus Normal Saline For Intraoperative Wound Irrigation on The Incidence of Surgical Site Infection in Clean-Contaminated Wounds After Gastroenterological Surgery: A Single-Institute, Prospective, Blinded-Endpoint, Randomized Controlled Trial.” Annals of Surgery, 2022.
S. Emile, A. Elfallal, M. A. Abdel-Razik, M. El-Said, and A. Elshobaky. “A Randomized Controlled Trial on Irrigation of Open Appendectomy Wound with Gentamicin- Saline Solution Versus Saline Solution for Prevention of Surgical Site Infection.” International Journal of Surgery, 2020.
S. P., S. S., Vijayakumar C., and P. C. “Role of Intraoperative Wound Irrigation with Antibiotics in Reducing Surgical Site Infection in Patients Undergoing Contaminated and Dirty Midline Laparotomy Surgical Wound: A Pilot Study.” International Surgery Journal, 2018.
Sulemana Abdul-Latif, J. Yorke, S. G. Brenu, J. Oppong, T. Buckman, F. Aitpillah, Jonathan Laryea, et al. “Evaluating the Efficacy of Dilute Povidone-Iodine Versus Normal Saline for Preventing Surgical Site Infections Following Appendectomy: A Prospective Observational Study in Ghanaian Tertiary Hospital.” BMC Surgery, 2025.
T. Abraham. “Prospective Randomised Controlled Trial to Assess the Effect of Normal Saline Wound Irrigation in Reducing Surgical Site Infection After Elective Open Colorectal Resections,” 2015.
T. Maatman, D. Weber, Lava R Timsina, B. Qureshi, E. Ceppa, A. Nakeeb, C. Schmidt, N. Zyromski, L. Koniaris, and M. House. “Antibiotic Irrigation During Pancreatoduodenectomy to Prevent Infection and Pancreatic Fistula: A Randomized Controlled Clinical Trial.” Surgery, 2019.
Tara C Mueller, M. Loos, B. Haller, A. Mihaljevic, U. Nitsche, D. Wilhelm, H. Friess, J. Kleeff, and F. Bader. “Intra-Operative Wound Irrigation to Reduce Surgical Site Infections After Abdominal Surgery: A Systematic Review and Meta-Analysis.” Langenbeck's Archives of Surgery (Print), 2015.
Tara C Mueller, Niel Mehraein, Victoria Kehl, Rebekka Dimpel, Helmut Friess, and D. Reim. “Antiseptic Wound Irrigation to Prevent Surgical Site Infection After Laparotomy: Meta-Analysis.” BJS Open, 2025.
Tara C Mueller, Rebekka Dimpel, V. Kehl, H. Friess, and D. Reim. “Surgical Site Infection Prevention in Abdominal Surgery: Is Intraoperative Wound Irrigation with Antiseptics Effective? Protocol for a Systematic Review and Meta-Analysis.” BMJ Open, 2023.
Tara C Mueller, U. Nitsche, V. Kehl, R. Schirren, B. Schossow, Ruediger Goess, H. Friess, and D. Reim. “Intraoperative Wound Irrigation to Prevent Surgical Site Infection After Laparotomy (IOWISI): Study Protocol for a Randomized Controlled Trial.” Trials, 2017.
Tara C Mueller, V. Kehl, Silvia Egert-Schwender, H. Friess, Alexander R. Novotny, and D. Reim. “Peritoneal Antiseptic Irrigation to Prevent Surgical Site Infection After Laparotomy for Hepatobiliary or Gastrointestinal Surgery (PAISI)—Protocol for a Randomized Controlled Study.” Trials, 2022.
Vinay Hg, Kirankumar, G. Rameshreddy, P. Arudhra, and B. Udayeeteja. “Comparison of the Efficacy of Povidone-Iodine and Normal Saline Wash in Preventing Surgical Site Infections in Laparotomy Wounds-Randomized Controlled Trial,” 2018.
Vinay Hg, and Ramesh Reddy. “IDDF2020-ABS-0014 Comparison of the Efficacy of Povidone-Iodine and Normal Saline Wash in Preventing Surgical Site Infections in Laparotomy Wounds-Randomized Controlled Trial.” Abstracts, 2020.
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