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Treatment strategy when using intraoperative peritoneal lavage for perforated appendicitis in children: a preliminary
Yasuharu Ohno1, Junichiro Furui, Takashi Kanematsu
1Division of Pediatric Surgery, Department of Surgery, Nagasaki University Graduate School of Medical Sciences, 1-7-1 Sakamoto, 852-8501, Japan. y-ohno@net.nagasaki-u.ac.jp
Insights
Peritoneal lavage with 5.8+/-1.54 L/m2 saline is needed to eliminate intraperitoneal bacteria in children with perforated appendicitis. Higher volumes (>6 L/m2) further reduce residual bacteria, guiding future treatment protocols.
Area of Science:
- Pediatric Surgery
- Infectious Disease Control
- Surgical Innovation
Background:
- Perforated appendicitis in children often leads to peritonitis.
- Optimal volume for intraoperative peritoneal lavage remains undetermined.
- Effective bacterial clearance is crucial for patient outcomes.
Purpose of the Study:
- To quantify the saline volume required for effective peritoneal lavage in pediatric perforated appendicitis.
- To determine the bacterial reduction efficacy of varying peritoneal lavage volumes.
Main Methods:
- Retrospective review of 11 children with perforated appendicitis and peritonitis.
- Intraoperative peritoneal lavage with large saline volumes.
- Peritoneal fluid culture before and after lavage to assess bacterial colony counts.
Main Results:
- 85% of bacterial species were resistant to 3-5 L/m2 saline lavage.
- Complete eradication of intraperitoneal bacteria required 5.8+/-1.54 L/m2.
- Volumes exceeding 6 L/m2 demonstrated a greater reduction in residual bacteria.
Conclusions:
- Significant bacterial reduction necessitates substantial volumes of peritoneal lavage fluid.
- Findings support the need for prospective randomized trials to establish optimal lavage volumes.
- This study provides preliminary data for refining peritonitis treatment in pediatric appendicitis.
Abstract:
We attempt to quantify the amount of peritoneal irrigation required to significantly decrease the intraperitoneal bacteria in children with perforated appendicitis, as no ideal volume of peritoneal lavage has yet been determined. A series of 11 children who were operated on for peritonitis caused by perforated appendicitis were reviewed retrospectively. All children were treated with our treatment protocol that included intraoperative peritoneal lavage using a large volume of saline. Peritoneal fluid samples were taken before and after peritoneal lavage and then were cultured to determine the colony counts. Twenty of 24 bacteria were available for evaluation of the changes in the flora counts. We found 85% of species to be resistant to peritoneal lavage when 3-5 l of saline per square meter of body surface area (l/m2) were used. In contrast, 5.8+/-1.54 l/m2 of peritoneal lavage fluid was necessary to completely eradicate the intraperitoneal bacterial flora. The residual bacteria showed a greater decrease when lavage fluid in excess of 6 l/m2 was used. Although this is only a preliminary report, these findings could be used to justify a true prospective randomized trial in the future.
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