Differential approach to preoperative preparations for diffuse purulent peritonitis in children

BACKGROUND: Diffuse purulent peritonitis is the most severe complication of abdominal surgical pathology accompanied by the development of serious metabolic disorders, and its elimination is a preoperative task.

AIM: This study aimed to compare traditional preoperative preparations using a new scheme that provides a differential approach considering the stage of peritonitis, degree of endotoxicosis, child’s age, and succinate administration.

MATERIALS AND METHODS: An analysis of the results of treatment of patients aged 1–14 years (average age 7.9 ± 3.9 years) with diffuse purulent peritonitis of various etiologies who were treated from 2006 to 2022 in the children’s surgical department of the V.D. Seredavin Samara Regional Hospital, Samara. The patients were divided into two groups. The main group included 237 patients who underwent preoperative preparation according to the proposed scheme (depending on age, peritonitis stage, and degree of endotoxemia) lasting at least 4–6 h. In addition, for intracorporeal detoxification, the antihypoxant meglumine sodium succinate was used. The control group comprised 102 children who received traditional therapy according to generally accepted approaches and national guidelines for pediatric surgery lasting 2–3 h. Changes in hemodynamic parameters, electrolytes, hematocrit, platelets, and blood gases were comprehensively examined.

RESULTS: After preoperative preparation, a statistically significant improvement in hemodynamic parameters was observed in the main group compared with that in the control group; the indicators were close to normal values. The dynamics of hematological parameters indicated more pronounced hemodilution in patients of the main group of all ages, which proves a significant improvement in the rheological properties of blood. Electrolyte and blood gas indicators did not reach the indicators of healthy children in any groups; however, in the main group, they were closer to normal. Complications of varying severity in the main group occurred in 21 children (8.8% ± 1.4%; p < 0.001), whereas in the control group, they were diagnosed in 47 patients (46.0% ± 4.6%). A statistically significant reduction in the length of stay of patients in the intensive care unit after surgery was noted in 80% of children in the main group.

CONCLUSIONS: The proposed scheme of preoperative preparation based on a differential approach using the antihypoxant meglumine sodium demonstrated greater effectiveness than traditional treatment. The composition, volume, and duration of preoperative preparation are dependent on the state of homeostasis and the age of the patient.