Saline versus Metronidazole Peritoneal Lavage in Operated Cases of PeritonitisA Longitudinal Study

Abstract

Introduction: Perforation peritonitis is a fairly common surgical problem. Despite recent advances in surgical practice, postoperative minor and major complications are common in patients of peritonitis. Intraoperative peritoneal lavage is an important operative management and the choice of fluid can affect the outcome. Aim: To compare the outcomes of peritoneal lavage using normal saline versus metronidazole in cases of perforation peritonitis in patients undergoing laparotomy, with respect to surgical site infections, sepsis, wound dehiscence, hospital stay. Materials and Methods: The present study was a longitudinal study done on 80 patients, divided in two groups with 40 cases in each group. In Group A, peritoneal cavity was lavaged with two litre of normal saline and closed after putting drains. In Group B peritoneal cavity was lavaged with two litre normal saline mixed with 100 mL (500 mg) of metronidazole and abdomen was closed in layers after placing two drains, kept closed for one hour after abdominal closure. Chi-square test was used, and p<0.05 was considered as level of significance. Results: The mean age of patients in metronidazole group was 47.72±15.64 years, and was comparable to mean age 45.92±15.26 years in saline group, difference was not significant (p=0.6039). Male/Female in both groups were 31/9 and 30/10, respectively. It was observed that the patients in metronidazole group had less surgical site infections (22.5%) compared to saline group 42.5% (p=0.056), less sepsis (20% vs 62.5%) (p<0.001), less wound dehiscence (5% vs 15%) (p=0.136), and shorter hospital stay with a mean±SD of 9.975±2.25 and 11.82±2.85 days (p=0.0019). Conclusion: The metronidazole lavage is better than saline lavage. However, larger multicentric randomised controlled trials need to be done.