In order to keep the catheters for drug instillation and abdominal drainage clear of blood clots and tissue debris, an abdominal lavage is begun in the operating room. This requires tubes and drains to be positioned prior to closure of the abdomen. We have utilized large volumes of fluid rapidly infused and then drained from the abdomen after a short dwell time. All intraabdominal catheters are withdrawn before the patient is discharged from the hospital. This may be caused by breast cancer, gastric cancer, mucinous malignancies of the colon or appendix, and ovarian cancer.
Intraperitoneal chemotherapy is uniformly successful in eliminating the debilitating ascites.
This usually requires three or four instillations of a systemic dose of appropriate chemotherapy into the peritoneal cavity. In a few patients, persistent ascites will require a debulking in order to separate bowel loops, remove bulk disease, and allow the use of a single cycle of heated intraoperative intraperitoneal chemotherapy. The resection generally includes the greater and lesser omentum and penduculated tumor masses. No attempt at a complete cytoreduction is made. The diseases treated and the results are indicated below.