The Choice of Surgical Tactics for Appendicular Peritonitis in Children

Abstract

This article presents the experience of using the modified Mannheim Peritonitis Index (MPI) score with an intraoperative assessment of the severity of peritonitis in children, taking into account the duration of the disease before surgery. Materials and Methods: We analyzed the results of treatment of 186 children under age 16 who were operated on for appendicular peritonitis in the period between 2011 and 2018. The method of scoring for appendicular peritonitis index (API) consists in summing up the points reflecting the risk factors for the disease. API provides 2 criteria for the severity of peritonitis: the first degree - API<10 points, the second degree - API≥10 points. Ten or more points are an indication for laparotomy. Results: With the definition of criteria for intraoperative assessment of the severity of peritonitis (API), the number of indications for laparotomy decreased. So, for the period from 2011 to 2014, the number of laparotomies performed with the subsequent programmed sanitation of the abdominal cavity was 17/14% cases; from 2015 to 2018, the inflammatory process in the abdominal cavity were assessed with the determination of the intraoperative index of peritonitis severity—the number of conversions was 15/11% cases.

Keywords

• appendicular peritonitis
• appendicular peritonitis index
• diagnostic laparoscopy