title: Effect of Peritoneal Lavage with Clindamycin-Gentamicin Solution on Post-Operative Pain and Analytic Acute-Phase Reactants after Laparoscopic Sleeve Gastrectomy.
abstract: BACKGROUND
  Peritoneal lavage has been proposed to remove bacterial contamination and other materials promoting bacterial proliferation and pro-inflammatory cytokines that may enhance local inflammation. The aims of this study were to evaluate the effects of peritoneal lavage with physiologic saline or an antibiotic solution (clindamycin-gentamicin) on post-operative pain and analytic acute-phase reactants and to determine the microbiologic impact of both irrigations on peritoneal contamination in patients undergoing laparoscopic sleeve gastrectomy (LSG) as a bariatric procedure.
  
  
  METHODS
  The patients were randomized into two groups: Those undergoing an intra-abdominal lavage with physiologic saline (Group 1; n = 40) and those undergoing a similar lavage with a gentamicin-clindamycin solution (Group 2; n = 40). Peritoneal contamination, post-operative pain, and analytic acute-phase reactants 24 h after surgery were investigated.
  
  
  RESULTS
  The median pain score 24 h after surgery was 3.5 in Group 1 and 1.5 in Group 2 (p = 0.021). The glucose concentration (mean difference 33.1 mg/dL; p = 0.004), aspartate aminotransferase (AST) concentration (mean difference 41.8 U/L; p = 0.009), alanine aminotransferase (ALT) concentration (mean difference 34.2 U/L; p = 0.029), white blood cell count (mean difference 1930/mm(3); p = 0.029); C-reactive protein concentration (mean difference 27.3 mg/L; p = 0.036), and serum lactic acid concentration (mean difference 0.34 mg/L; p = 0.049) were significantly higher in Group 1. Peritoneal contamination also was significantly higher in Group 1 (17.5% vs 0; p = 0.006).
  
  
  CONCLUSIONS
  Intra-peritoneal irrigation with a gentamicin and clindamycin solution in patients undergoing LSG leads to a reduction in post-operative pain and peritoneal contamination, less alteration of acute-phase reactants, lower blood glucose concentration, a smaller increase in liver enzymes, and a shorter hospital stay.
authors.affiliation: 1 Department of Surgery, General University Hospital Elche , Alicante, Spain .
authors.forename: Jaime
authors.initials: J
authors.lastname: Ruiz-Tovar
authors.affiliation: 2 Department of Surgical Nursery, Hospital del Sureste , Madrid, Spain .
authors.forename: Carolina
authors.initials: C
authors.lastname: Llavero
authors.affiliation: 3 Department of Anesthesiology, General University Hospital Elche , Alicante, Spain .
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Muñoz
authors.affiliation: 1 Department of Surgery, General University Hospital Elche , Alicante, Spain .
authors.forename: Lorea
authors.initials: L
authors.lastname: Zubiaga
authors.affiliation: 1 Department of Surgery, General University Hospital Elche , Alicante, Spain .
authors.forename: Maria
authors.initials: M
authors.lastname: Diez
mesh_terms: D000209:Acute-Phase Proteins / Q000378:metabolism*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001202:Ascitic Fluid / Q000382:microbiology; D015415:Biomarkers / Q000097:blood; D002981:Clindamycin / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005743:Gastrectomy / Q000379:methods; D005839:Gentamicins / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D010533:Peritoneal Lavage / Q000379:methods*; D016037:Single-Blind Method; D012996:Solutions; D013530:Surgical Wound Infection / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D000900:Anti-Bacterial Agents; D015415:Biomarkers; D005839:Gentamicins; D012996:Solutions; D002981:Clindamycin