Comparative Study of Result of Peritoneal Wash with Normal Saline Vs Saline and Metronidazole in Patients Undergoing Exploratory Laparotomy for Perforation Peritonitis

Introduction: Perforation peritonitis is a significant surgical emergency with high postoperative infectious morbidity. During exploratory laparotomy, lavage with normal saline is routine, and the addition of metronidazole may be useful for providing additional antimicrobial activity against anaerobic organisms. This study compared postoperative outcomes following saline lavage with or without metronidazole. Materials and Methods: This randomized clinical trial was carried out in the Department of General Surgery, Sanjay Gandhi Memorial Hospital, Delhi between March 2024 and August 2025. 54 patients, 18-60 years of age, with perforation peritonitis undergoing exploratory laparotomy were randomly divided into two equal groups. Group 1 (n=27) was given 2L of normal saline with 100ml of metronidazole and Group 2 (n=27) was given 2L of normal saline alone. Surgical site infection (SSI), sepsis, intra-abdominal abscess, wound dehiscence, burst abdomen and hospital stay were evaluated. Categorical variables were analyzed using Chi-square test and p value <0.05 was taken as statistically significant. Results: Age, gender and etiology of perforation were similar at baseline. The metronidazole group had a significantly lower SSI than the saline group (18.52% vs. 48.15%, p=0.0209). Postoperative sepsis was also significantly reduced (25.93% vs. 59.26%; p=0.0132). Intra-abdominal abscess, wound dehiscence and burst abdomen were numerically lower with metronidazole, but were not statistically significant. There was a significant difference in terms of hospital stay, with 77.78% discharged within 10 days compared with 40.74% (p=0.0056). Conclusion: Postoperative SSI and sepsis rates and hospital stay were significantly reduced after exploratory laparotomy for perforation peritonitis when metronidazole was added to normal saline for peritoneal lavage. These results suggest that lavage with metronidazole is a helpful addition to standard saline lavage.