Introduction: This study aimed to determine if massive intra-abdominal irrigation reduced the risk of postoperative intra-abdominal abscess (PO-IAA) after laparoscopic appendectomy (LA) for perforated appendicitis in pediatric patients. Materials and Methods: A case-control study was conducted at Saitama Prefectural Children’s Medical Center between January 2014 and December 2023. Sixty-nine pediatric patients with perforated appendicitis who underwent LA were included. Patients were divided into PO-IAA and PO-IAA-free groups. We compared the irrigation volume (IV), the ratio of IV to body weight (IV/BW), and the ratio of IV to body surface area (IV/BSA) between the two groups. Statistical analyses were performed to identify significant differences and optimal cutoff values. Results: The PO-IAA-free group had a significantly higher IV (median 8000 mL vs. 6000 mL, p = 0.014), IV/BW (270.9 mL/kg vs. 159.2 mL/kg, p = 0.009), and IV/BSA (7500.6 mL/m2 vs. 4890.6 mL/m2, p = 0.008) than the PO-IAA group. Receiver operating characteristic curve analysis identified cutoff values of 6000 mL for IV, 234.6 mL/kg for IV/BW, and 6352.2 mL/m2 for IV/BSA. Conclusions: Massive intra-abdominal irrigation during LA for perforated appendicitis in children may be effective in preventing PO-IAA. Additionally, IV/BW and IV/BSA may be indicators that determine the IV.
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