Inflammatory peritoneal reaction after perforated appendicitis: continuous peritoneal lavage versus non lavage.
BACKGROUND
Bacterial peritonitis is a severe medical condition associated with a natural mortality rate of 80-100%. Progress in surgical techniques, new developments in intensive care medicine and antibiotic therapy reduced this rate significantly. Aim of this study was to evaluate sepsis parameter in perforated appendicitis and different postoperative management.


METHODS
In 50 consecutive patients with diffuse bacterial peritonitis and perforated appendicitis, laparotomy was performed. Subsequently, 25 patients were treated with adjuvant, continuous peritoneal lavage (CPL) using standard peritoneal dialysis (CAPD)-solution. The remaining 25 patients were peritoneally drained without postoperative irrigation (Non-CPL). In all patients endotoxin, tumor necrosis factor-alpha (TNF-alpha), interleukin (IL-6), C-reactive protein (CRP) and myeloid-related protein (MRP-8, MRP-14 and Heterocomplex) were determined.


RESULTS
No difference in clinical outcome between CPL and Non-CPL could be established. An uncomplicated clinical outcome was associated with lower levels of inflammation markers. Furthermore, clinical data revealed that mortality depended on co-morbidity, and patient's age.


CONCLUSIONS
In perforated appendicitis a faster decrease of mediator release could not be achieved with either method. In addition, no difference could be established for the clinical parameters like hospitalization, duration of intensive care and morbidity.
Schwarz
A
A
Department of Surgery, KH Lindau, 88131 Lindau, Germany. andreas.schwarz@krankenhaus-lindau.de
Bölke
E
E
Peiper
M
M
Schulte am Esch
J
J
Steinbach
G
G
van Griensven
M
M
Orth
K
K
D000328:Adult; D000367:Age Factors; D001064:Appendicitis / Q000150:complications*; D019540:Area Under Curve; D040501:Calgranulin A / Q000032:analysis; D040502:Calgranulin B / Q000032:analysis; D015897:Comorbidity; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000032:analysis; D008297:Male; D010533:Peritoneal Lavage; D010538:Peritonitis / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D040501:Calgranulin A; D040502:Calgranulin B; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha