Predictors of peritoneal lavage use in pediatric open appendectomy: A retrospective study

Sevgi Ulusoy Tangul; Hulya Ipek; Atilla Senayli

doi:10.5281/zenodo.17148273

Authors

Sevgi Ulusoy Tangul Department of Pediatric Surgery, Faculty of Medicine, Kırklareli University, Kırklareli, Turkey https://orcid.org/0000-0003-4573-1504
Hulya Ipek Department of Pediatric Surgery, Faculty of Medicine, Corum Hitit University, Çorum, Turkey https://orcid.org/0000-0002-3496-8939
Atilla Senayli Department of Pediatric Surgery, Faculty of Medicine, Kırklareli University, Kırklareli, Turkey https://orcid.org/0000-0002-9994-8162

DOI:

https://doi.org/10.5281/zenodo.17148273

Keywords:

Appendectomy, peritoneal lavage, pediatrics

Abstract

Objective: This study aims to identify the clinical and diagnostic parameters influencing the decision to perform peritoneal lavage during pediatric open appendectomy.

Materials and methods: The files of patients who underwent open appendectomy due to acute appendicitis were retrospectively scanned. The patients were divided into two groups based on whether peritoneal lavage was performed. Age, gender, accompanying symptoms, physical examination findings, hemoglobin, leukocyte, C-reactive protein (CRP), abdominal ultrasonography (USG), abdominal tomography (CT) findings, intraoperative findings, and hospital stay duration of the groups were recorded.

Results: The mean age and hemoglobin values of the peritoneal lavage group were statistically significantly lower than those without lavage (p<0.05). Fever, vomiting, nausea, diarrhea, rebound, and CRP were higher in the lavage group (p<0.05). Leukocyte count and symptom onset time were statistically significantly lower in the no-lavage group (p<0.05). A statistically significant negative correlation existed between age, hemoglobin, CRP levels, and peritoneal lavage. There was a statistically significant and positive relationship with other parameters (p<0.05). According to the results of binary logistic analysis, CT and hemoglobin parameters were also substantial in multivariate analysis (p<0.05).

Conclusion: While many factors affect the decision to perform peritoneal lavage in univariate analysis, CT findings and hemoglobin levels are significant parameters in multivariate analysis.

References

Zhou Q, Meng W, Ren Y, Li Q, Boermeester MA, Nthumba PM, et al. Effectiveness of intraoperative peritoneal lavage with saline in patients with intra-abdominal infections: a systematic review and meta-analysis. World J Emerg Surg. 2023;18(1):24.

Gammeri E, Petrinic T, Bond-Smith G, Gordon-Weeks A. Meta-analysis of peritoneal lavage in appendicectomy. BJS Open. 2019;3(1):24-30.

Daskalopoulou D, Kankam J, Ambe P, Zarras K. Single-center retrospective analysis of outcomes of patients undergoing staged peritoneal lavage for secondary peritonitis. World J Surg. 2020;44(7):2185-90.

Sneiders D, Lambrichts D, Swank H, Blanken-Peeters C, Nienhuijs S, Govaert M, et al. Long-term follow-up of a multicentre cohort study on laparoscopic peritoneal lavage for perforated diverticulitis. Colorectal Dis. 2019;21(6):705-14.

Pak LM, Coit DG, Eaton AA, Allen PJ, D’Angelica MI, DeMatteo RP, et al. Percutaneous peritoneal lavage for the rapid staging of gastric and pancreatic cancer. Ann Surg Oncol. 2017;24(5):1174-9.

Parisi A, Gemini A, Desiderio J, Petrina A, Trastulli S, Grassi V, et al. Laparoscopic peritoneal lavage: our experience and review of the literature. Videosurgery Miniinv. 2016;11(2):83-7.

Feng C, Su X, Zhou X, Wang LL, Li B, Chen L, et al. Early peritoneal lavage with ulinastatin improves outcome and enhances multi-organ protection in a model of severe acute pancreatitis. Exp Ther Med. 2015;9(4):1171-7.

Gow KW, Haley LP, Phang PT. Validity of visual inspection of diagnostic peritoneal lavage fluid. Can J Surg. 1996;39(2):114-6.

Zhu C, Zhang S, Zhong H, Gu Z, Kang Y, Pan C, et al. Intra-abdominal infection in acute pancreatitis in eastern China: microbiological features and a prediction model. Ann Transl Med. 2021;9(6):489.

Silva-Nunes J, Cardoso T. Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment. BMC Infect Dis. 2019;19(1):980.

Sartelli M, Catena F, Abu-Zidan FM, Ansaloni L, Biffl WL, Boermeester MA, et al. Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference. World J Emerg Surg. 2017;12:29.

Bi LW, Yan BL, Yang QY, Cui HL. Peritoneal irrigation vs suction alone during pediatric appendectomy for perforated appendicitis: a meta-analysis. Medicine (Baltimore). 2019;98(50):e18047.

Abu A, Mohamedahmed AY, Alamin A, Mohamed M, Osman M, Mohammed MJ, et al. Evaluation of drain insertion after appendicectomy for complicated appendicitis: a systematic review and meta-analysis. Cureus. 2022;14(11):e31831.

Iglesias NJ, Arrowood R, Montgomery L, Leeper E, Tsao KJ, Iglesias JL. Operative time is independently associated with morbidity in pediatric complicated appendicitis. J Surg Res. 2022;276:143-50.

Kotan C, Karaayvaz M, Daşdemir I, Barut I, Özgören E. Effectiveness of peritoneal dry cleaning method in surgical treatment of intra-abdominal infections. Van Tıp Derg. 1999;6(2):22-5.

Uğur M, Koca YS, Çetin R. Effects of intraoperative peritoneal cleansing methods on peritoneal adhesion in gastric perforations. Turk J Surg. 2012;28(1):21-5.

Perović Z. Drainage of the abdominal cavity and complications in perforating appendicitis in children. Med Pregl. 2000;53(3-4):193-6.