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Perforated appendicitis with generalized peritonitis. Prospective, randomized evaluation of closed postoperative
T A Buanes1, G P Andersen, U Jacobsen
1Surgical Department, Ullevaal Hospital, Oslo, Norway.
The European Journal of Surgery = Acta Chirurgica
|April 1, 1991
Summary
Closed postoperative peritoneal lavage did not improve outcomes for perforated appendicitis with generalized peritonitis. This intervention, involving closed peritoneal lavage, showed no significant clinical benefit and carried risks, suggesting it is not a recommended treatment.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Infectious Disease Management
Background:
- Perforated appendicitis with generalized peritonitis presents significant treatment challenges.
- Systemic antibiotics and initial peritoneal irrigation are standard care.
- The role of additional closed postoperative peritoneal lavage (CPPL) remains debated.
Purpose of the Study:
- To evaluate the therapeutic value of CPPL in patients with perforated appendicitis and generalized peritonitis.
- To compare postoperative infection rates and clinical outcomes between patients receiving CPPL and those not.
Main Methods:
- A prospective, randomized study design.
- Patients received peroperative peritoneal irrigation, systemic ampicillin, and tinidazole.
- Random allocation to either CPPL (n=39) or no CPPL (control, n=44).
Main Results:
- Postoperative infection occurred in 10/39 (25.6%) in the CPPL group versus 4/44 (9.1%) in the control group (p > 0.05).
- Intra-abdominal infections were rare in both groups (1/39 vs 2/44).
- CPPL was discontinued prematurely in 10 cases due to complications or lack of perceived benefit.
Conclusions:
- Closed postoperative peritoneal lavage demonstrated no statistically significant clinical benefit in this series of perforated appendicitis with generalized peritonitis.
- The procedure is associated with costs and potential complications, without clear advantages over standard care.
- Further investigation may be warranted, but the current evidence suggests limited utility for CPPL in this context.