Saline solution vs. stabilized isotonic sodium hypochlorite lavage in complicated appendicitis: a comparative study

There is no clear consensus on whether peritoneal lavage should be used in complicated appendicitis, nor which solution is ideal. This study evaluated the outcomes of two different intraperitoneal lavage solutions in adult patients with complicated appendicitis. We conducted a prospective analytical comparative study including adult patients with complicated appendicitis treated by open appendectomy between January 2023 and July 2024. Patients were allocated according to intraoperative availability of lavage solution to either saline solution (SS) lavage or stabilized isotonic sodium hypochlorite solution (SISHS) lavage. Primary outcomes were length of hospital stay, postoperative complications within 30 days, and total direct treatment costs. A total of 120 patients were included (60 per group). Baseline demographic and clinical characteristics were comparable. Mean hospital stay was significantly shorter in the SISHS group compared with the SS group (1.86 ± 0.60 vs 6.15 ± 5.59 days; p = 0.004). Postoperative complications, including wound infection, seroma, abdominal wall abscess, intra-abdominal abscess, postoperative ileus, pain, and abdominal distension, were less frequent in the SISHS group (all p < 0.05). Reoperations were required in 21 patients in the SS group and in none of the SISHS group. Total direct treatment costs were 42.8% lower in the SISHS group. These findings suggest that SISHS lavage may offer favorable postoperative outcomes, including shorter hospital stays, lower complication rates, and reduced direct treatment costs in adult patients undergoing open appendectomy for complicated appendicitis. Further controlled studies are needed to confirm these findings.