3Role of Pre Operative Peritoneal Lavage in Patients of Perforation Peritonitis

Abstract

Background- Perforation peritonitis is amongst the most common emergency condition in surgical practice and is a common cause of mortality in tropical countries like ours. Factors contributing to the high mortality rate include advanced age, late presentation, septicaemia, comorbidities and delay in the treatment. Previous literature has shown peritoneal drainage does improve morbidity and mortality. Not much literature is available on role of NS in pre-operative peritoneal lavage. Aims and Objectives - To assess and compare the morbidity, mortality and final outcomes of the patients who were given peritoneal lavage pre operatively with patients who were not given peritoneal lavage in the pre-operative period. Material and Method- 60 Patients, with generalised perforation peritonitis; reporting in MMIMSR, MMDU, Mullana, Ambala (Haryana); were included in this Randomised control study and divided into two groups. Group I (study group) underwent pre-operative peritoneal lavage under local anaesthesia and group II (control group) without pre-operative peritoneal lavage. The Mannheim’s peritonitis index (MPI) of the patients was calculated and was used to estimate the probable outcome/prognosis of the patient. The haemodynamic parameters and vitals of the patient were recorded just before surgery, before induction of anaesthesia as well as at the end of procedure. On discharge the duration of stay of each patient, complication, suture site infection, recovery period were recorded and analysed using the appropriate statistical tests. Results The ratio of male: female population in the study was found to be 5:1. 26 patients had MPI score of >25, 22 patients had scores between 15-25 and 12 patients had score of <15. In the study group after giving peritoneal lavage 80% (24/30) patients were stable while 20% (6/30) were unstable just before surgery, while in the control group 63.3% (19/30) were stable while 37.7% (11/30) were unstable. Only 20 cases (33.3%) required the ventilatory support later. 48 cases were discharged after recovery whereas 12 cases (20 %) expired. Favourable outcomes were seen in 93.3% (28 cases) of the lavage group and only 6.7 % cases expired. Conclusion- The pre-operative percutaneous peritoneal aspiration of the fluid and peritoneal irrigation and drainage in patients with advanced stage of perforation peritonitis documented by their high MPI score before definitive surgical source control is associated with a significant improvement in the pre operative pulse rate and blood pressure, a decrease in the overall mortality and deep seated wound infection and dehiscence.