Inflammatory peritoneal reaction after perforated appendicitis: continuous peritoneal lavage versus non lavage

Area of Science:

• Surgical critical care
• Peritonitis research
• Inflammatory marker analysis

Background:

• Bacterial peritonitis, a severe condition, historically has high mortality (80-100%).
• Advances in surgery, intensive care, and antibiotics have reduced mortality rates.
• Perforated appendicitis with diffuse bacterial peritonitis presents a significant clinical challenge.

Purpose of the Study:

• To evaluate sepsis parameters in perforated appendicitis.
• To compare continuous peritoneal lavage (CPL) with standard non-irrigated drainage post-appendicitis surgery.
• To assess the impact of postoperative management on inflammatory markers and clinical outcomes.

Main Methods:

• Fifty patients with diffuse bacterial peritonitis and perforated appendicitis underwent laparotomy.
• Twenty-five patients received adjuvant continuous peritoneal lavage (CPL) with CAPD solution.
• The remaining 25 patients had standard peritoneal drainage (Non-CPL).
• Endotoxin, TNF-alpha, IL-6, CRP, and MRPs were measured in all patients.

Main Results:

• No significant difference in clinical outcomes was observed between the CPL and Non-CPL groups.
• Lower levels of inflammation markers correlated with uncomplicated clinical outcomes.
• Patient mortality was primarily influenced by co-morbidity and age, not the surgical technique.

Conclusions:

• Continuous peritoneal lavage did not accelerate mediator release reduction in perforated appendicitis.
• Neither CPL nor Non-CPL showed differences in hospitalization duration, intensive care unit stay, or morbidity.
• Postoperative management via CPL or standard drainage did not alter key clinical parameters in this patient cohort.