Application of an electrolyzed strongly acidic aqueous solution before wound closure in colorectal surgery.

Background: Electrolyzed strongly acidic aqueous solution which is produced by electrolysis of a sodium chloride solution has been used in Japan for the irrigation of wounds or body cavities even in the absence of particular evidence.

Objective: The purpose of this study is to investigate the efficacy or harmful effects of the disinfectant when applied before wound closure in colorectal surgery.

Design: We performed a prospective, randomized study.

Setting: The study was conducted at Surgical Department of Hyogo College of Medicine

Patients: Patients who underwent elective colorectal surgery were randomly assigned to 2 groups. The surgical wound was irrigated with >500 mL of the disinfectant or saline solution after the completion of fascia closure. Patients with dirty/infected wounds were excluded from the study.

Main Outcome Measures: The primary end point of this study was comparison of the frequency of incisional surgical site infection. The secondary end point was the occurrence of wound dehiscence or wound hernia.

Results: One hundred eighty patients in the disinfectant group and 183 patients in the saline solution group were analyzed. In multivariate analysis, IBD and contaminated wounds were independent risk factors for incisional surgical site infection. Application of the disinfectant tended to lower the risk of the infection (OR 0.457, 95% CI 0.206-1.013). In the analysis of poor wound healing, preoperative hospital stay of >2 weeks, stoma creation, and use of the disinfectant (OR 2.28, 95% CI 1.03-5.04) were independent risk factors.

Limitation: This study was not a double-blind trial.

Conclusions: Application of electrolyzed strongly acidic aqueous solution to the wound impaired wound healing. Routine use of electrolyzed strongly acidic aqueous solution is not recommended in patients undergoing elective colorectal surgery. As for the contribution of the disinfectant to preventing wound infections, further study is needed to make a definitive conclusion.