Prospective Randomised Control Study to Evaluate the Effectiveness of Hypochlorous Acid as a Peritoneal Lavage Agent to Prevent Surgical Site Infection After Exploratory Laparotomy for Perforation Peritonitis

Introduction Surgical site infections (SSIs) are a major concern following emergency gastrointestinal procedures, particularly exploratory laparotomy for perforation peritonitis, where infection risk is amplified by the inherent contamination of the operative field. Despite prophylactic antibiotics, the microbial burden frequently surpasses host defence thresholds. Intraoperative peritoneal lavage with antimicrobial agents such as hypochlorous acid (HOCl) has emerged as a promising strategy, combining physical removal of contaminants with direct microbicidal action. Methods This was a prospective, randomized controlled trial and 148 patients were included in the study who presented with peritonitis secondary to gastrointestinal perforation. Participants were randomly assigned to receive intraoperative lavage using either HOCl (Group A) or normal saline (Group B). The primary endpoint was the rate of SSIs within 30 days postoperatively. Secondary outcomes included early wound progression, postoperative fever, and rates of wound healing by postoperative days 15 and 30. Additional variables such as patient demographics, comorbidities, surgical parameters, and anatomical factors were evaluated. Results The HOCl group demonstrated a marked reduction in SSI incidence (20.3%) compared to the saline group (39.2%), yielding an absolute risk reduction of 19%. Early postoperative indicators - wound severity escalation and fever by day 3 - were predictive of subsequent SSI. No statistically significant associations were found between infection rates and patient-related or operative variables. By day 15, 79% of patients in the HOCl group showed complete wound healing, significantly outperforming the saline group (50%, p<0.001). All HOCl-treated wounds achieved complete healing by day 30. No adverse reactions or resistant organisms were identified among HOCl intraperitoneal lavage recipients. Conclusion Intraperitoneal hypochlorous acid lavage has a significant role in reducing the rate of SSI in perforation peritonitis cases.