Peritoneal Lavage Versus Drainage for Perforated Appendicitis
in Children
Akira Toki, Kaoru Ogura, Tadashi Horimi, Hirohumi Tokuoka, Takuji Todani,
Yasuhiro Watanabe, Sadashige Uemura, Naoto Urushihara, Takuo Noda, Yasuhisa
Sato, Yoshiki Morotomi, Kiyoshi Sasaki
Surg Today 25: 207-210, 1995
A total of 231 children with acute appendicitis were treated
at our hospitals during the 10 years between 1984 and 1993, 53 of whom had
a perforated appendix. These 53 patients were randomly assigned to two groups
at the time of surgery according to the different procedures performed.
Thus, 29 children were managed by appendectomy followed by peritoneal lavage
using a large amount of saline, and intravenous antibiotic therapy consisting
of aminoglycoside and cephem (lavage group), while the other 24 children
were treated by appendectomy with silicon tube drainage and the same systemic
antibiotic therapy (drainage group) . The mean length of hospitalization,
and the mean duration of fever and the need for fasting after laparotomy
in the lavage group were significantly less than those in the drainage group:
10.1 versus 18.8 days, 2.8 versus 7.7 days, and 1.8 versus 3.5 days, respectively.
The operation wounds healed well in the lavage group due to the fact that
there was no drain. Wound infections occurred in two children from the lavage
group and six from the drainage group. Intra-abdominal abscesses occurred
in two children from the drainage group. Accordingly, peritoneal lavage
appears to be superior to intraperitoneal tube drainage for the management
of perforated appendicitis in children.
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