Prophylaxis of Adhesions with Trasylol in Cases of Perforated Appendicitis in Children

Abstract

The anti-adhesive action of Trasylol (aprotinin) has been demonstrated in animal experiments. In clinical practice this positive anti-adhesive action could only be deduced based on the absence of complications reported. In the present report the authors describe the use of the anti-adhesive characteristics of Trasylol in the prevention of mechanical ileus following surgery for perforated appendicitis in children. Few reports on this subject have been published. During a two year investigation period two groups of patients were selected for study. The first group included 58 patients to whom Trasylol was administered locally, in the peritoneal cavity, at a dose of 500,000 K.I.U. irrespective of the child's age. The second group of 112 patients received no such treatment. The difference in numbers between the two groups arises from the fact that the majority of surgeons do not use Trasylol. The anti-adhesive effect of the drug was evaluated by determining the incidence of mechanical ileus requiring treatment by surgical intervention in each of the two groups under study. Care has been taken to assess the influence of such factors as operative technique and antibiotic therapy in the outcome of the results of this study. Eleven cases of mechanical ileus were reported in the group receiving no Trasylol treatment and in four of these patients a second surgical intervention was required for recurrence of adhesive ileus. A slightly higher incidence of other post-operative complications, severe infections and dehiscence of the wound, was also noted in the untreated group. No cases of mechanical ileus were reported in the group of patients treated with Trasylol. In addition it is suggested that Trasylol may be of value in the attenuation of post-operative shock.