Does massive irrigation reduce the risk of intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis?

Purpose This study aimed to determine if massive intra-abdominal irrigation reduced the risk of postoperative intra-abdominal abscess (PO-IAA) after laparoscopic appendectomy (LA) for perforated appendicitis in pediatric patients. Methods A case-control study was conducted at Saitama Prefectural Children’s Medical Center from January 2014 to December 2023. Sixty-nine pediatric patients with perforated appendicitis who underwent LA were included. Patients were divided into PO-IAA and PO-IAA-free groups. We compared the irrigation volume (IV), ratio of IV to body weight (IV/BW), and ratio of IV to body surface area (IV/BSA) between the two groups. Statistical analyses were performed to identify significant differences and optimal cutoff values. Results The PO-IAA-free group had a significantly higher IV (median 8000 mL vs. 6000 mL, p = 0.014), IV/BW (270.9 mL/kg vs. 159.2 mL/kg, p = 0.009), and IV/BSA (7500.6 mL/m² vs. 4890.6 mL/m², p = 0.008) than the PO-IAA group. Receiver operating characteristic curve analysis identified cutoff values of 6000 mL for IV, 234.6 mL/kg for IV/BW, and 6352.2 mL/m² for IV/BSA. Conclusion Massive intra-abdominal irrigation during LA for perforated appendicitis in children may be effective in preventing PO-IAA.