Abdominal Cavity Irrigation For The Acute Pediatric Perforated Appendicitis

Objective: Compared with acute non-perforated appendicitis,the children with acute perforated appendicitis always have a slow recovery and postoperative complications.And also,there is a controversy on the treatment of peritoneal suppuration in acute perforated appendicitis.In this study,we compare the effect of different methods on the Peritoneal Suppuration in acute Pediatric perforated appendicitis by prospective study.Methods: From September 2019 to December 2019,the clinical data of 84 cases with acute perforated appendicitis admitted to the general surgical department of Shanghai Children’s Hospital was collected.71/84 cases who treated by laparoscopic appendectomy were included in this study.Those cases were randomly divided into 3 groups: group 1(diluted povidone-iodine group,PVI),group 2(normal saline group,NS)and group 3(control group).In group 1,24 patients were irrigated with 500 ml diluted PVI solution(concentration=0.05%)twice in peritoneal cavity after suction of suppuration.In group 2,23 children were treated with equal amount of normal saline by the same method.And in group 3,24 children were not given any irrigation.The following clinical data was collected: agenda,age,time of onset,WBC,CRP and NEUT%,antibiotic administration,time of postoperative intake,temperature,peritoneal suppuration culture,rectal irritation,intra-abdominal infection mass,intestinal obstruction,hospital stay,hospitalization cost,readmission.All the data was analyzed by SPSS22.0.P<0.05 indicated that the difference was statistically significant.Results: There were no significant differences in agenda,age,time of onset,preoperative WBC,CRP and NEUT%,antibiotic administration and peritoneal suppuration culture among these 3groups(all P > 0.05).Compared with group 2,the patients in group1 have had faster postoperative intake(28.8 ± 9.3 vs 32.5 ± 8.7h,P< 0.0001),lower CRP(64.8 ± 32.4 vs 45.1 ± 20.5mg/l,P < 0.0001),shorter hospital stay(8.96 ± 1.97 vs 9.75 ± 2.21 d,P = 0.002),and less hospitalization cost(21977 ± 2330 vs 22152 ± 2758 ￥,P <0.0001).Compared with group 3,the patients in group 1 have had faster return to normal temperature(22.5 ± 9.2 vs 29.7 ± 9.3 h,P <0.0001),faster postoperative intake(28.8 ± 9.3 vs 31.6 ± 10.3 h,P< 0.0001),lower CRP(64.8 ± 32.4 vs 41.3 ± 18.6 mg / L,P <0.0001),smaller maximum diameter of intra-abdo minal infection mass(1.20 ± 0.82 vs 1.90 ± 1.09 cm,P = 0.031),shorter hospital stay(8.96 ± 1.97 vs 9.67 ± 2.23 d,P = 0.015),less hospitalization cost(21977 ± 2330 vs 22799 ± 4223 ￥,P < 0.0001).Compared with group 3,the patients group 2 have had faster being of normal temperature(24.3 ± 7.7 vs 29.7 ± 9.3 h,P < 0.0001)and less hospitalization expenses(22152 ± 2758 vs 22799 ± 4223 ￥,P <0.0001).There was no significant statistical difference among the others data.Conclusion: Co mpared with either of being irrigated with normal saline or with only suction of peritoneal suppuration in laparoscopic appendectomy for acute pediatric perforated appendicitis,intra-abdominal irrigation with diluted PVI solution can reduce the infla mmation of disease,shorten the hospitalization time,reduce the hospitalization cost and cut down the intra-abdo minal infection mass,and accelerate the recovery of patient.This method c ould be a choice of treat ment for the peritoneal suppuration in children with perforated appendicitis.