Saline versus metronidazole peritoneal lavage in operated cases of peritonitis

Background: Peritonitis is a life-threatening surgical emergency most often caused by gastrointestinal perforations. Intraoperative peritoneal lavage aids in reducing infectious load, but saline alone lacks antimicrobial properties. Metronidazole lavage may enhance infection control by directly targeting anaerobes within the peritoneal cavity. Aims and Objectives: The objective of the study is to compare the effectiveness of intraoperative metronidazole lavage versus saline lavage in reducing post-operative complications, sepsis, and hospital stay in patients undergoing surgery for secondary peritonitis. Materials and Methods: This prospective randomized interventional study was conducted in the Department of General Surgery, Maharani Laxmi Bai Medical College, Jhansi, over 18 months. A total of 100 adult patients with perforation peritonitis were randomized into two groups: Group A (n=50) received saline plus metronidazole lavage, whereas Group B (n=50) received saline alone. Baseline demographics, causes of perforation, operative details, post-operative complications, and outcomes were recorded. Data were analyzed using Statistical Package for the Social Sciences v21, with Chi-square and t-tests applied; P<0.05 was considered statistically significant. Results: The mean age was 47.8 years, with males comprising 67%. Gastric perforation was the most common cause (42%). Mean operative time was shorter in the metronidazole group (116.58 min) compared to saline (134.88 min), though not significant (P=0.07). Post-operative superficial surgical site infection (SSI) was lower in Group A (20%) than Group B (40%, P=0.04). Severe sepsis (systemic inflammatory response syndrome >2) occurred in 22% versus 44%, respectively (P=0.03). Mean hospital stay was significantly reduced in the metronidazole group (5.9 vs. 8.1 days, P=0.001). Conclusion: Metronidazole lavage significantly reduced post-operative sepsis, SSIs, and length of hospital stay, making it a safe, effective, and economical adjunct in peritonitis surgery.