Emergency Surgery Comparative Study of Saline Solution (SS) versus Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) in Peritoneal Lavage in Open Appendectomy to Prevent Complications of Complicated Appendicitis in 120 Adults from México

Emergency Surgery Comparative Study of Saline Solution (SS) versus Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) in Peritoneal Lavage in Open Appendectomy to Prevent Complications of Complicated Appendicitis in 120 Adults from México | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Emergency Surgery Comparative Study of Saline Solution (SS) versus Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) in Peritoneal Lavage in Open Appendectomy to Prevent Complications of Complicated Appendicitis in 120 Adults from México Milton Alberto Muñoz-Leija, Marion Carolina Alemán-Jiménez, Ramón González-Lemus, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7482183/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Feb, 2026 Read the published version in European Journal of Trauma and Emergency Surgery → Version 1 posted 9 You are reading this latest preprint version Abstract There is no clear consensus on whether peritoneal lavage should be used or not, nor which solution is ideal to use, this research focused on evaluating the outcomes of using two different types of solutions and protocols for intraperitoneal lavage in adult patients diagnosed with complicated appendicitis. The sample (n=120) was divided into two groups: Saline Solution (SS) Group (n=60) which uses 2,000 mL irrigation for 3-5 minutes with subsequent excess elimination and Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) Group (n=60) which uses 443 mL irrigation for 2 minutes with subsequent suction. After performing the surgical procedure of open appendectomy, the postoperative hospital stay (total days) was evaluated along with rates of the complications (frequency and percentage) occurring within one month (30 days) after surgery. At the end the total cost of treatment was calculated for each group. Regarding postoperative hospital stay, the SISHS group required only 1.86 ± 0.6 days versus the 6.15 ± 5.59 days required by the SS group, with a statistically significant difference (p = 0.004), concerning to adverse events at 30 days, these were generally less frequent with statistically significant differences (p = 0.01 to p = 0.002) in the SISHS group compared to the SS group (with exception of hypothermia), finally the total treatment cost for the SISHS group was 42.8% cheaper compared to the SS group. These findings represent a promising therapeutic option, considering the favorable outcomes manifested by a shorter hospital stay, lower frequency of adverse events 1 month after surgery and total healthcare costs observed in the SISHS group. Appendicitis Peritoneal Lavage Saline Solution & Peritonitis Figures Figure 1 Background Appendicitis is the leading cause of acute abdomen, 1 – 3 with a lifetime incidence of 16% 4–5 and a post-appendectomy mortality rate of less than 1%. 6 – 7 It can present as localized or generalized, with 55% of cases being complicated (acute appendicitis accompanied by peritonitis, appendiceal rupture, gangrene, intra-abdominal abscess, intraperitoneal fecaliths, intraoperative mass, and/or purulent material within the cavity). 8 – 9 Without perforation, 5% of cases experience postoperative complications. In cases with perforation, over 50% develop postoperative complications, primarily surgical site infection, intra-abdominal abscess, abdominal wall abscess, necrotizing fasciitis, and paralytic ileus. 10 – 12 In cases of perforation, intraperitoneal lavage is commonly used, a practice described since the 20th century. 13 Saline solution is routinely employed due to its availability, although other solutions like povidone-iodine, chlorhexidine gluconate, or antibiotic dilutions have been reported by various authors. These alternative solutions are controversial due to potential adverse effects such as cytotoxicity and the development of bacterial resistance, 14 – 19 although benefits, such as reduced postoperative intra-abdominal abscesses with povidone-iodine irrigation in pediatric patients with perforated appendicitis, have also been reported, ¹⁷ in the same population (pediatric patients) the use of high irrigation volume (3–12 liters) has been associated with a reduction of subsequent abdominal infection by serial dilution in perforated and non-perforated appendicitis. ²⁰ In 2019, Gammeri et al. performed a secondary review and meta-analysis comparing isolated suction versus saline lavage effectiveness in complicated and uncomplicated appendicitis, associating lavage with reduced hospital stays and recommending studies with other solutions. 21 Due to their bacteriostatic and bactericidal properties, 22 neutral pH electrolyzed superoxidation solutions (SES) have been among the latest options, associated with reduced postoperative complications in laparoscopic abdominal surgery for acute abdomen. 23 In 2023, Zou et al. conducted a systematic review and meta-analysis regarding saline intraperitoneal lavage for intraabdominal infections, determining very low-quality evidence and recommending further studies. 24 Laparoscopic studies show favorable outcomes with copious (minimum of 2000 mL sterile normal saline) irrigation in adults with complicated appendicitis 25 but unfavorable outcomes in pediatric populations also with complicated appendicitis. 26 Given the controversy between adverse events and favorable outcomes reported with solutions for peritoneal lavage, 14 – 20 , recommendations from other authors to evaluate non-saline solutions, 21 low-quality evidence from previous studies, the necessity for additional research, 24 and contradictory results from recent studies employing similar methods in different populations (adult versus pediatric), 25 – 26 this group opted to conduct the present study. Objectives Compare the results in terms of postoperative hospital stay (total days), rates of the complications (frequency and percentage) occurring within one month (30 days) and treatment group total cost of treatment for two groups: One group managed conventionally with saline solution lavage, referred to as the Saline Solution (SS) group and a second group treated with isotonic stabilized sodium hypochlorite solution lavage, designated as the Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) group (Fig. 1 ). Patients and Materials After obtaining approval from the corresponding committees (R-2024-1912-028), a prospective (with follow-up at 1 week, 2 weeks, and 30 days), analytical (comparative) study was conducted at Hospital General de Zona con Medicina Familiar #6 [Zone 6 General Hospital with Family Medicine], part of the Mexican Social Security Institute, in northeastern Mexico (Nuevo León Delegation). The technique used was determined based on surgeon availability and preference. Prior to the procedure, all the participants in this study signed have provided a consent to participate and also signed an informed consent, and each patient and a witness (patient’s relative) received a thorough explanation regarding the chosen technique, its availability, benefits, alternatives and potential complications, making emphasis in the voluntary nature of their participation, the adequate understanding of all the given information, the right of free choice and the possibility of leaving the study at any time. The procedures were carried out between January 2023 and July 2024. All patients included in this study were over 18 years of age, diagnosed with complicated appendicitis (localized abscess or generalized peritonitis). All patients underwent conventional (open) appendectomy via an infraumbilical midline incision (laparoscopy was not used due to lack of supplies). The Pouchet appendectomy technique using free silk 2 − 0 was employed in all cases. In the SISHS group, following aspiration of purulent material and appendectomy, the abdominal cavity was irrigated with 443 mL of SISHS. After 2 minutes within the cavity, excess fluid was suctioned out. In the SS group, following aspiration of purulent material and appendectomy, lavage was performed with 2,000 mL of saline solution (SS), and the excess fluid was removed after 3–5 minutes. All patients received antibiotic prophylaxis preoperatively with a single dose of ceftriaxone (1 gram) and metronidazole (750 mg), and antibiotic therapy continued during hospitalization until culture results of the purulent material became available, at which point targeted antibiotic therapy was initiated. A Penrose drain was placed in all patients. Statistical analysis Considering the characteristics of this study, sample size calculation was performed for cases and controls with a precision of 5 mm, statistical power of 90%, and two-tailed significance level (0.15). According to reported literature, the estimated prevalence of complications was 50%, 10 – 12 resulting in an estimated minimum of 42 patients per group. However, it was decided to increase the sample size to 60 patients per group due to convenience and availability, utilizing a convenience sampling method. Statistical analysis was performed using a database created with Excel (version 2024) for iOS, subsequently analyzed using SPSS Statistics (version 24.1) for macOS. Absolute frequencies and proportions were reported for qualitative variables. The Kolmogorov–Smirnov test was applied to evaluate normality; means and standard deviations were calculated for parametric variables, and medians with interquartile ranges for non-parametric variables. Independent samples were analyzed using Student’s t-test or the Mann–Whitney U test (for quantitative variables such as age, based on distribution of data). Qualitative variables were analyzed using Chi-square or Fisher’s exact test. A p-value < 0.05 was considered statistically significant. Results A total of 120 patients were evaluated, with 60 patients in each group. Of the total population, 58.33% were male. The overall mean age was 37.62 ± 14.75 years. In the Saline Solution (SS) Group, the mean age was 39.28 ± 15.73 years, and in the Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) Group, it was 35.96 ± 13.77 years, with no statistically significant difference (p = 0.889). The average duration of appendicitis symptoms prior to surgery was 2.70 ± 1.46 days, with no statistically significant difference between the two groups (p = 0.214). The main comorbidities observed in the patients were systemic arterial hypertension (28.3%) and type 2 diabetes mellitus (27.5%). The mean BMI of the study population was 30.14 ± 4.28 kg/m² (obesity range). No statistically significant differences were observed between the two groups regarding these parameters (Table 1 ). Laboratory parameters did not show statistically significant differences between groups, except for total bilirubin (p = 0.001), direct bilirubin (p = 0.041), and C-reactive protein (p = 0.030) (Table 2 ). The average length of hospital stay overall was 4.00 ± 3.09 days, with a mean of 6.15 ± 5.59 days in the SS Group and 1.86 ± 0.6 days in the SISHS Group (Graph 1), demonstrating a statistically significant difference (p = 0.004). (Graph 1). Postoperative complications differed significantly between the two groups: seroma (p = 0.001), abdominal wall abscess (p = 0.01), wound infection (p = 0.02), abdominal distension (p = 0.002), surgical pain (p = 0.001), postoperative ileus (p = 0.01), and intra-abdominal abscess (p < 0.001) (Table 3 ). Clinical parameters after surgery also showed statistically significant differences between groups: leukocytosis (p < 0.001), tachycardia (p = 0.01), tachypnea (p < 0.001), hypotension (p < 0.001) and fever (p = 0.006). Hypothermia did not show any statistically significant difference (p = 0.170) (Table 4 ). Table 1. Descriptive Profile of Participants Variable General SS SISHS P Gender (M/F) M: 70 (58.33%)F: 50 (41.66%) M: 36 (60%)F: 24 (40%) M: 34 (56.67%) F: 26 (43.33%) 0.208 0.312 Age (years) 37.62 ± 14.75 39.28 ± 15.73 35.96 ± 13.77 0.889 Symptom duration (days) 2.70 ± 1.46 2.90 ± 1.19 2.81 ± 1.74 0.214 Medical history T2DM 33 (27.5%) 18 (30%) 15 (25%) 0.485 SAH 34 (28.3%) 14 (23.33%) 20 (33.33%) 0.194 HIV 1 (0.83%) 1 (1.67%) 0 (0%) 0.542 HTG 3 (2.5%) 1 (1.67%) 2 (3.33%) 0.590 PWE 1 (0.83%) 0 (0%) 1 (1.67%) 0.602 BMI (kg/m²) 30.14 ± 4.28 29.43 ± 4.11 30.8 ± 4.4 0.064 Table 1. Descriptive Profile of Participants. SS: Saline Solution; SISHS: Stabilized Isotonic Sodium Hypochlorite Solution; M: Male; F: Female; T2DM: Type 2 Diabetes Mellitus; SAH: Systemic Arterial Hypertension; HIV: Human Immunodeficiency Virus; HTG: Hypertriglyceridemia; PWE: Person with Epilepsy; BMI: Body Mass Index. Table 2. Biochemical Profile of Participants Variable General SS SISHS P Leukocytes (cells/μL) 16.71 ± 4.1 16.14 ± 4.42 17.28 ± 3.87 0.13 Neutrophils (% WBC) 86.27 ± 5.58 85.77 ± 5.58 86.77 ± 5.58 0.25 Hemoglobin (g/dL) 14.84 ± 0.96 14.5 ± 1.89 15.19 ± 1.13 0.08 Platelets (cells/μL) 303.5 ± 70 292 ± 69.5 316 ± 70.6 0.06 Glucose (mg/dL) 114.4 ± 46.6 121.7 ± 62.5 107.14 ± 30.8 0.97 Creatinine (mg/dL) 0.86 ± 0.40 0.83 ± 0.40 0.90 ± 0.40 0.229 Total Bilirubin (mg/dL) 0.82 ± 0.35 0.72 ± 0.40 0.92 ± 0.30 0.001* Direct Bilirubin (mg/dL) 0.55 ± 0.42 0.40 ± 0.24 0.7 ± 0.6 0.041* Indirect Bilirubin (mg/dL) 0.27 ± 0.2 0.25 ± 0.23 0.30 ± 0.2 0.348 AST (U/L) 29.8 ± 17.3 27.02 ± 15.8 32.7 ± 18.9 0.924 ALT (U/L) 31.2 ± 18.8 28.90 ± 19.21 33.5 ± 18.52 0.188 Sodium (mEq/L) 136.5 ± 3.47 136.5 ± 3.27 136.55 ± 3.67 0.937 CRP (mg/dL) 61.1 ± 28.0 55.5 ± 24.0 66.8 ± 31.9 0.030* Potassium (mEq/L) 3.91 ± 0.41 3.91 ± 0.41 3.98 ± 0.34 0.281 Table 2. Biochemical Profile of Participants. SS: Saline Solution; SISHS: Stabilized Isotonic Sodium Hypochlorite Solution; WBC: White Blood Cells; *: Clinically Significant Difference; AST: Aspartate Aminotransferase; ALT: Alanine Aminotransferase; CRP: C-reactive Protein. Table 3. Percentage of complications at 30 days in both groups Complication General SS SISHS P Seroma 43 (35.83%) 30 (50%) 13 (21.67%) 0.001* Abdominal Wall Abscess 20 (16.67%) 15 (25%) 5 (8.33%) 0.01* Wound Infection 31 (25.8%) 22 (36.67%) 9 (15%) 0.02* Abdominal Distension 46 (38.33%) 32 (53.33%) 14 (23.33%) 0.002* Surgical Pain 30 (25%) 24 (40%) 6 (10%) 0.001* Postoperative Ileus 25 (20.83%) 18 (30%) 7 (11.67%) 0.01* Intra-abdominal Abscess 16 (13.33%) 16 (26.67%) 0 (0%) 0.001* Table 3. Percentage of complications at 30 days in both groups. SS: Saline Solution; SISHS: Stabilized Isotonic Sodium Hypochlorite Solution. Table 4. Postoperative clinical parameters in both groups Parameter General SS SISHS P Leukocytosis 32 (26.67%) 24 (40%) 8 (13.33%) 0.001* Tachycardia 25 (20.83%) 18 (30%) 7 (11.67%) 0.01* Tachypnea 10 (8.33%) 10 (16.67%) 0 (0%) 0.001* Hypotension 4 (3.33%) 4 (6.67%) 0 (0%) 0.001* Fever 44 (36.67%) 31 (51.67%) 13 (21.67%) 0.006* Hypothermia 3 (2.5%) 2 (3.33%) 1 (1.67%) 0.170 Table 4. Postoperative clinical parameters in both groups. SS: Saline Solution; SISHS: Stabilized Isotonic Sodium Hypochlorite Solution Although the cost of the Anasept unit was 11.4 times higher than the saline solution unit (80.00 USD versus 7.00 USD), due to the shorter hospital stay and reduced complications, the use of Anasept was associated with a 42.8% reduction in the average total cost per group (422,695.00 USD in SS group versus 241,751.00 USD in SISHS group; USD:MXN of 1.00:20.00, calculated in Nov 2024). Discussion Intra-abdominal infections are common surgical emergencies and a frequent cause of non-traumatic hospital mortality. 27 Key elements for optimal management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early stabilization when necessary. 28 in general surgery he strategic use of irrigation and drain placement may be useful in some circumstances, 29 despite multiple recommendations for managing intra-abdominal infections, the use of antiseptic solutions is usually limited to surgical sites, and controversy remains due to their potential tissue toxicity. 30 Among the studies reviewed for this manuscript, particular attention was given to a controlled clinical trial by Anderson et al. (2020), comparing povidone-iodine irrigation versus no irrigation in patients with perforated appendicitis. The povidone-iodine irrigation was associated with fewer postoperative complications and a shorter hospital stay. However, this study focused exclusively on a pediatric population with a single pathology (perforated appendicitis). 17 In 2021, Valdés-Pineda et al. associated the use of neutral-pH superoxidized electrolyzed solution (SES) with reduced complications and shorter hospital stays compared to saline irrigation and no irrigation. Although that study targeted adults, it should be noted that patients treated did not exclusively have complicated appendicitis, as the study included conditions such as gallbladder perforation, complicated diverticulitis, and even uncomplicated appendicitis. Moreover, the sample size for each group was small, unbalanced (31, 22, and 25 patients respectively), and not calculated based on statistical power, 23 thus predisposing to potential bias. In the context of laparoscopic surgery, an adult study evaluating the use of copious saline irrigation (at least 2,000 mL) combined with suction versus suction alone for complicated appendicitis found that saline irrigation was associated with a lower incidence of intra-abdominal abscesses, faster postoperative recovery, and reduced hospital costs. 25 In contrast, a pediatric study linked intraperitoneal saline irrigation plus suction in complicated appendicitis with prolonged hospital stay, more temperature peaks, longer surgical time, and more readmissions due to intra-abdominal collections compared to suction alone. 26 Our study has several strengths, including standardized pathology under evaluation (complicated appendicitis), a homogeneous adult population, a sample size greater than calculated requirements, and a comparison of the commonly used solution (saline solution). Initially, the open surgical approach was preferred over laparoscopy, as it is the procedure most frequently employed in our clinical setting. The primary factor limiting the use of cytotoxic solutions is their potential for adverse cytotoxic effects. 14–19 A commonly employed strategy to reduce antiseptic cytotoxicity while maintaining effectiveness is dilution. 31 Full-strength Dakin’s solution contains 0.5% sodium hypochlorite, and half-strength Dakin’s solution contains 0.25% sodium hypochlorite. Both solutions have demonstrated antimicrobial effects; however, their use has been limited due to cytotoxicity in fibroblasts and delayed wound healing. 32 In the early 1990s, it was demonstrated that a “modified Dakin’s solution” with a reduced sodium hypochlorite concentration of 0.025% retained bactericidal efficacy without cytotoxicity. 33 A recent study evaluated the cytotoxicity of various antiseptics on human fibroblast and keratinocyte cultures, determining that sodium hypochlorite (NaOCl) had the least detrimental effects, and therefore should be considered the least aggressive antiseptic for developing new therapeutic strategies. 34 In 1997, Fleishmann et al. first demonstrated the benefits of combining negative pressure wound therapy (NPWT) with intermittent instillation of antiseptics or antibiotics in wounds involving exposed bone, soft tissues, and chronic wounds. 35 Successful use of antibiotic solutions selected according to antibiograms has been reported in complex abdominal wounds. 36 In abdominal sepsis, better outcomes have thus far been reported with saline solution instillation compared with negative-pressure temporary abdominal closure alone. 37 The Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) used in this study is commercially known as Anasept. Anasept is a modified Dakin’s solution with notable characteristics including: It is non-cytotoxic. It contains sodium hypochlorite at a concentration of 0.057%. It is isotonic. 38 It demonstrates antimicrobial activity by reducing bacterial growth from high concentrations (10⁷) to undetectable levels. 39 Consequently, its use should be considered in managing intra-abdominal infections. Notably, although the Jerusalem guidelines state in Statement 5.2 that “peritoneal irrigation does not have any advantages over suction alone in complicated appendicitis,” this conclusion is based on results obtained using saline irrigation. 40 The solution employed in this study has antimicrobial properties, 39 and recommendations for managing intra-abdominal infections emphasize adequate source control and appropriate antimicrobial therapy. 28 Considering concerns about potential tissue toxicity, 30 it is noteworthy that the solution utilized is regarded as non-cytotoxic. 38 Conclusions Complicated appendicitis has a high rate of postoperative complications. Limited high-quality evidence is available in the literature to establish an absolute consensus regarding the optimal surgical technique for complicated appendicitis. The Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) Group demonstrated greater effectiveness compared to the conventional Saline Solution (SS) Group technique. Patients in the SISHS Group experienced fewer postoperative complications and shorter hospital stays following surgery. The SISHS Group also represented savings in total group care costs. Further studies are necessary to establish definitive management protocols and truly assess the effectiveness of different surgical techniques and irrigation solutions reported in the literature. Abbreviations BMI: Body Mass Index Inc: Incorporation iOS: iPhone Operating System macOS: Macintosh Operating System mg: Milligrams mL: Milliliters MXN: Mexican Peso NPWT: negative pressure wound therapy n: number NaOCl: sodium hypochlorite p: probability value pH: potential of hydrogen SS: Saline Solution SES: Superoxidation Electrolyzed Solutions SISHS: Stabilized Isotonic Sodium Hypochlorite Solution SPSS: Statistical Package for the Social Sciences USA: United States of America USD: United States Dollar Declarations Acknowledgements. Acknowledgment to all members of the Department of General Surgery at Hospital General de Zona No. 6, Mexican Social Security Institute (IMSS), Nuevo León, Mexico. We would like to express our sincere gratitude to Javier Humberto Martínez-Garza for his invaluable inspiration, mentorship and support. Authors' contributions. Milton Alberto Muñoz-Leija: Conceptualization, Project administration, Data curation, Resources, Methodology, Formal analysis, Writing-original Draft, Writing-Review & Editing. Marion Carolina Alemán-Jiménez: Conceptualization, Project administration, Data curation, Formal analysis, Writing- Original Draft. Ramón González-Lemus: Project administration, Data curation, Resources, Writing-Review & Editing. Raúl Dario Martínez-Carvajal: Conceptualization, Project administration, Supervision, Resources. Saúl Tóvar-López: Conceptualization, Project administration, Supervision, Resources. Alejandro Quiroga-Garza: Conceptualization, Data curation, Formal Analysis, Writing - Original Draft. Armando Magdaleno Joya-Munguía:Supervision, Data Curation, Writing - Review & Editing. Heliodoro Plata-Álvarez Project administration, Data curation, Resources, Writing - Review & Editing, Supervision. Funding. This study didn't receive any funds or grants. Availability of data and materials. The datasets used for the present study are available from the corresponding author (Muñoz-Leija, [email protected] ) on reasonable request. Ethical Approval and Consent to participate. This project was evaluated and approved by the corresponding ethics committee and the corresponding research committee. Both committes assigned the approval number R-2024-1912-028. Consent for publication. Written informed consent was obtained from all participants or their legal representatives for publication data. Competing interests. The authors declare no competing interests. References Cheng Y, Zhou S, Zhou R, et al. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. CDSR. 2015;2:CD010168. 10.1002/14651858.cd010168.pub2 . Rehman H, Rao AM, Ahmed I. Single incision versus conventional multi-incision appendicectomy for suspected appendicitis. CDSR. 2011;11:CD009022. 10.1002/14651858.cd009022.pub2 . Wilms IM, Hoog DE, Visser DC, Janzing HM. 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BJS Open. 2018;3(1):24–30. https://doi.org/10.1002/bjs5.50118 . Marcos-Tejedor F, Sánchez-Rodríguez R, Mayordomo R, Martínez-Nova A. The bacteriostatic effect of controlled-flux electrolyzed acidic solution on healthy hallucal skin. JCT. 2020;29(1):58–60. https://doi.org/10.1016/j.jtv.2019.10.006 . Valdés-Pineda JO, Gutiérrez-Hernández LR, López-Cabrera J, et al. Results of abdominal cavity lavages with neutral electrolyzed water in patients with acute abdomen approached by laparoscopic surgery compared to physiological saline solution lavages or no lavages. Rev Mex Cir Endoscop. 2021;21(4):191–9. Zhou Q, Meng W, Ren Y, et al. Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis. World J Emerg Surg. 2023;18(1):24. 10.1186/s13017-023-00496-6 . Sun F, Wang H, Zhang F, et al. Copious irrigation versus suction alone during laparoscopic appendectomy for complicated appendicitis in adults. J Invest Surg. 2017;31(4):342–6. 10.1080/08941939.2017.1319995 . Puttock D, Kumbhar V, Dagash H, Patwardhan N. Peritoneal lavage during laparoscopic appendectomy for complex appendicitis is associated with increased post-operative morbidity. Afr J Paediatr Surg. 2022;19(4):241–4. 10.4103/ajps.ajps_146_21 . Sartelli M, Coccolini F, Kluger Y, et al. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections. World J Emerg Surg. 2021;16(1):49. 10.1186/s13017-021-00387-8 . Sartelli M, Tascini C, Coccolini F, et al. Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use. World J Emerg Surg. 2024;19(1):23. 10.1186/s13017-024-00551-w . Weiser TG, Forrester JD, Forrester JA. Tactics to Prevent Intra-Abdominal Infections in General Surgery. Surg Infect. 2019;20(2):139–45. https://doi.org/10.1089/sur.2018.282 . Mueller TC, Loos M, Haller B, et al. Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg. 2015;400(2):167–81. https://doi.org/10.1007/s00423-015-1279-x . Rheinbaben FV, Köhnlein J, Schmidt N, Hildebrandt C, Werner S. To reduce cytotoxicity when testing the virucidal activity of chemical disinfectants and biocides: The T-25 method as an alternative to large-volume-plating. Heliyon. 2023;9(10):e20728. 10.1016/j.heliyon.2023.e20728 . Haesler E, Carville K. WHAM evidence summary: traditional hypochlorite solutions. WCET J. 2023;43(1):35–40. 10.33235/wcet.43.1.35-40 . Heggers JP, Sazy JA, Stenberg BD, et al. Bactericidal and Wound-Healing Properties of Sodium Hypochlorite Solutions: The 1991 Lindberg Award. J Burn Care Rehabil. 1991;12(5):420–4. https://doi.org/10.1097/00004630-199109000-00005 . Ortega-Llamas L, Quiñones-Vico MI, García-Valdivia M, et al. Cytotoxicity and Wound Closure Evaluation in Skin Cell Lines after Treatment with Common Antiseptics for Clinical Use. Cells. 2022;11(9):1395. https://doi.org/10.3390/cells11091395 . Fleischmann W, Russ M, Westhauser A, Stampehl M. Vacuum-sealing-technique used as drug release system for topical treatment of wound infections. Unfallchirurg. 1998;101(8):649–54. 10.1007/s001130050318 . García-Ruano A, García-Fernández S, Mahedero-Navarrete S, Lasso-Vázquez JM, Pérez-Cano R. Innovador tratamiento de heridas abdominales complejas mediante terapia de presión negativa con instilación intermitente. Cir plast iberolatinoam. 2013;39(3):209–17. 10.4321/s0376-78922013000300001 . Sibaja-Álvarez P, Sánchez-Betancourt A, Fernández LG. Negative Pressure Wound Therapy with Instillation in the Septic Open Abdomen Utilizing a Modified Negative Pressure Therapy System. Ann Med Surg (Lond). 2018;36:246–51. https://doi.org/10.1016/j.amsu.2018.10.007 . ANACAPA TECHNOLOGIES. anasept Antimicrobial Skin & Wound Cleanser. anasept Antimicrobial Skin and Wound Care Products. Accessed July 22. 2025, http://static.webareacontrol.com/CommonFile/anacapa-anasept-antimicrobialskinandwoundcleanser-1699938167212.pdf Federal Drug Administration. Device: Anasept™ Antimicrobial Skin and Wound Gel Section D: 510(K) Summary Anacapa™ Technologies, Inc. 510(k) Premarket Notification. Accessed July 22. 2025. https://www.accessdata.fda.gov/cdrh_docs/pdf7/K073547.pdf Di Saverio S, Birindelli A, Kelly MD, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016;11(1):34. 10.1186/s13017-016-0090-5 . Graph Graph 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Graph1.png Graph 1. Difference in average hospital stay between the two groups Cite Share Download PDF Status: Published Journal Publication published 16 Feb, 2026 Read the published version in European Journal of Trauma and Emergency Surgery → Version 1 posted Editorial decision: Revision requested 15 Nov, 2025 Reviews received at journal 01 Nov, 2025 Reviewers agreed at journal 05 Oct, 2025 Reviews received at journal 03 Sep, 2025 Reviewers agreed at journal 02 Sep, 2025 Reviewers invited by journal 02 Sep, 2025 Editor assigned by journal 02 Sep, 2025 Submission checks completed at journal 01 Sep, 2025 First submitted to journal 28 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7482183","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":509715183,"identity":"51111079-c8bb-46aa-8e05-d6e0e7c6dd37","order_by":0,"name":"Milton Alberto Muñoz-Leija","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIiWNgGAWjYDACZuYGECVjAOYZ2MgxtoMEDCzwaGFsBCnhAWphbGAoSDNm7jkA0iKBxxoULR8OJ7bPSAAJ49ai287Y/uDjDjsec/be5w8+GBxO7J35/OqGHwUSDPzt3QnYtJgdZmxsnHkmmcey57hh4wyDdOOZs3PKbvYAHSZx5uwGXFqaeduYeQxupDE28xhYy26cnZN2gweoxUAiF5+Weh6D+89AWpgZ9988k3bzD2Eth4G2sIG0OCs2zmA/dpuQLTNnth0H+iWNceYMgzRjxp4cttsyBhI8OP1y/vCBDx/bquXM2Y8xfPjwBxSVx5/dfANk8Lf3YtWCDfCAUwIPscpBgP0BKapHwSgYBaNg+AMAp6pnkqw4BuIAAAAASUVORK5CYII=","orcid":"","institution":"Mexican Social Security Institute","correspondingAuthor":true,"prefix":"","firstName":"Milton","middleName":"Alberto","lastName":"Muñoz-Leija","suffix":""},{"id":509715184,"identity":"e8a6532b-f80b-4099-9dcb-a6b24a465cde","order_by":1,"name":"Marion Carolina Alemán-Jiménez","email":"","orcid":"","institution":"Universidad Autónoma de Nuevo León","correspondingAuthor":false,"prefix":"","firstName":"Marion","middleName":"Carolina","lastName":"Alemán-Jiménez","suffix":""},{"id":509715185,"identity":"bbac39d7-c753-4a69-9898-406c14881cfa","order_by":2,"name":"Ramón González-Lemus","email":"","orcid":"","institution":"BIVIUM International, Inc.","correspondingAuthor":false,"prefix":"","firstName":"Ramón","middleName":"","lastName":"González-Lemus","suffix":""},{"id":509715186,"identity":"306e2c07-78c9-43df-9605-a9c2c4b423ab","order_by":3,"name":"Raúl Dario Martínez-Carvajal","email":"","orcid":"","institution":"Mexican Social Security Institute","correspondingAuthor":false,"prefix":"","firstName":"Raúl","middleName":"Dario","lastName":"Martínez-Carvajal","suffix":""},{"id":509715188,"identity":"3f336e95-26f0-4040-b37e-caf12d5be3fc","order_by":4,"name":"Saúl Tóvar-López","email":"","orcid":"","institution":"Mexican Social Security Institute","correspondingAuthor":false,"prefix":"","firstName":"Saúl","middleName":"","lastName":"Tóvar-López","suffix":""},{"id":509715190,"identity":"2199d78b-f8c9-409b-871c-11ba5baac706","order_by":5,"name":"Alejandro Quiroga-Garza","email":"","orcid":"","institution":"Universidad Autónoma de Nuevo León","correspondingAuthor":false,"prefix":"","firstName":"Alejandro","middleName":"","lastName":"Quiroga-Garza","suffix":""},{"id":509715191,"identity":"80208df5-07cf-451f-b5e1-252cb8b1828b","order_by":6,"name":"Armando Magdaleno Joya-Munguía","email":"","orcid":"","institution":"Hospital Joya","correspondingAuthor":false,"prefix":"","firstName":"Armando","middleName":"Magdaleno","lastName":"Joya-Munguía","suffix":""},{"id":509715192,"identity":"70564026-ede4-4b03-afe0-aea9d3af9372","order_by":7,"name":"Heliodoro Plata-Álvarez","email":"","orcid":"","institution":"Mexican Social Security Institute","correspondingAuthor":false,"prefix":"","firstName":"Heliodoro","middleName":"","lastName":"Plata-Álvarez","suffix":""}],"badges":[],"createdAt":"2025-08-28 16:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7482183/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7482183/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00068-026-03086-8","type":"published","date":"2026-02-16T15:57:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90910207,"identity":"16c2c1a3-3c5b-4c82-b4ba-33616b9a1c2b","added_by":"auto","created_at":"2025-09-09 13:36:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54573,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy Flowchart.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSS: Saline Solution; SISHS: Stabilized Isotonic Sodium Hypochlorite Solution.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7482183/v1/a5425e4ed8e54b0296962952.png"},{"id":103251082,"identity":"08311015-751a-430e-8ecc-f0997484c7c3","added_by":"auto","created_at":"2026-02-23 16:03:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":852539,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7482183/v1/489d1476-265e-4ad2-895e-8efac5729af5.pdf"},{"id":90910204,"identity":"20bedb24-86ab-44d5-9afb-96ecc500b903","added_by":"auto","created_at":"2025-09-09 13:36:16","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":63663,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraph 1. Difference in average hospital stay between the two groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Graph1.png","url":"https://assets-eu.researchsquare.com/files/rs-7482183/v1/e92c10ec50d6f68ca86cdf1d.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Emergency Surgery Comparative Study of Saline Solution (SS) versus Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) in Peritoneal Lavage in Open Appendectomy to Prevent Complications of Complicated Appendicitis in 120 Adults from México","fulltext":[{"header":"Background","content":"\u003cp\u003eAppendicitis is the leading cause of acute abdomen, \u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e with a lifetime incidence of 16% \u003csup\u003e4\u0026ndash;5\u003c/sup\u003e and a post-appendectomy mortality rate of less than 1%. \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e It can present as localized or generalized, with 55% of cases being complicated (acute appendicitis accompanied by peritonitis, appendiceal rupture, gangrene, intra-abdominal abscess, intraperitoneal fecaliths, intraoperative mass, and/or purulent material within the cavity). \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Without perforation, 5% of cases experience postoperative complications. In cases with perforation, over 50% develop postoperative complications, primarily surgical site infection, intra-abdominal abscess, abdominal wall abscess, necrotizing fasciitis, and paralytic ileus. \u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn cases of perforation, intraperitoneal lavage is commonly used, a practice described since the 20th century. \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Saline solution is routinely employed due to its availability, although other solutions like povidone-iodine, chlorhexidine gluconate, or antibiotic dilutions have been reported by various authors. These alternative solutions are controversial due to potential adverse effects such as cytotoxicity and the development of bacterial resistance, \u003csup\u003e\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e although benefits, such as reduced postoperative intra-abdominal abscesses with povidone-iodine irrigation in pediatric patients with perforated appendicitis, have also been reported, \u0026sup1;⁷ in the same population (pediatric patients) the use of high irrigation volume (3\u0026ndash;12 liters) has been associated with a reduction of subsequent abdominal infection by serial dilution in perforated and non-perforated appendicitis. \u0026sup2;⁰\u003c/p\u003e\u003cp\u003eIn 2019, Gammeri et al. performed a secondary review and meta-analysis comparing isolated suction versus saline lavage effectiveness in complicated and uncomplicated appendicitis, associating lavage with reduced hospital stays and recommending studies with other solutions. \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Due to their bacteriostatic and bactericidal properties, \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e neutral pH electrolyzed superoxidation solutions (SES) have been among the latest options, associated with reduced postoperative complications in laparoscopic abdominal surgery for acute abdomen. \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e In 2023, Zou et al. conducted a systematic review and meta-analysis regarding saline intraperitoneal lavage for intraabdominal infections, determining very low-quality evidence and recommending further studies. \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Laparoscopic studies show favorable outcomes with copious (minimum of 2000 mL sterile normal saline) irrigation in adults with complicated appendicitis \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e but unfavorable outcomes in pediatric populations also with complicated appendicitis. \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eGiven the controversy between adverse events and favorable outcomes reported with solutions for peritoneal lavage, \u003csup\u003e\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18 CR19\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003c/sup\u003e recommendations from other authors to evaluate non-saline solutions, \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e low-quality evidence from previous studies, the necessity for additional research, \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e and contradictory results from recent studies employing similar methods in different populations (adult versus pediatric), \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e this group opted to conduct the present study.\u003c/p\u003e"},{"header":"Objectives","content":"\u003cp\u003eCompare the results in terms of postoperative hospital stay (total days), rates of the complications (frequency and percentage) occurring within one month (30 days) and treatment group total cost of treatment for two groups: One group managed conventionally with saline solution lavage, referred to as the Saline Solution (SS) group and a second group treated with isotonic stabilized sodium hypochlorite solution lavage, designated as the Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) group (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatients and Materials\u003c/h2\u003e\u003cp\u003eAfter obtaining approval from the corresponding committees (R-2024-1912-028), a prospective (with follow-up at 1 week, 2 weeks, and 30 days), analytical (comparative) study was conducted at \u003cem\u003eHospital General de Zona con Medicina Familiar #6\u003c/em\u003e [Zone 6 General Hospital with Family Medicine], part of the Mexican Social Security Institute, in northeastern Mexico (Nuevo Le\u0026oacute;n Delegation). The technique used was determined based on surgeon availability and preference. Prior to the procedure, all the participants in this study signed have provided a consent to participate and also signed an informed consent, and each patient and a witness (patient\u0026rsquo;s relative) received a thorough explanation regarding the chosen technique, its availability, benefits, alternatives and potential complications, making emphasis in the voluntary nature of their participation, the adequate understanding of all the given information, the right of free choice and the possibility of leaving the study at any time. The procedures were carried out between January 2023 and July 2024. All patients included in this study were over 18 years of age, diagnosed with complicated appendicitis (localized abscess or generalized peritonitis).\u003c/p\u003e\u003cp\u003eAll patients underwent conventional (open) appendectomy via an infraumbilical midline incision (laparoscopy was not used due to lack of supplies). The Pouchet appendectomy technique using free silk 2\u0026thinsp;\u0026minus;\u0026thinsp;0 was employed in all cases. In the SISHS group, following aspiration of purulent material and appendectomy, the abdominal cavity was irrigated with 443 mL of SISHS. After 2 minutes within the cavity, excess fluid was suctioned out. In the SS group, following aspiration of purulent material and appendectomy, lavage was performed with 2,000 mL of saline solution (SS), and the excess fluid was removed after 3\u0026ndash;5 minutes. All patients received antibiotic prophylaxis preoperatively with a single dose of ceftriaxone (1 gram) and metronidazole (750 mg), and antibiotic therapy continued during hospitalization until culture results of the purulent material became available, at which point targeted antibiotic therapy was initiated. A Penrose drain was placed in all patients.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eConsidering the characteristics of this study, sample size calculation was performed for cases and controls with a precision of 5 mm, statistical power of 90%, and two-tailed significance level (0.15). According to reported literature, the estimated prevalence of complications was 50%, \u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e resulting in an estimated minimum of 42 patients per group. However, it was decided to increase the sample size to 60 patients per group due to convenience and availability, utilizing a convenience sampling method. Statistical analysis was performed using a database created with Excel (version 2024) for iOS, subsequently analyzed using SPSS Statistics (version 24.1) for macOS. Absolute frequencies and proportions were reported for qualitative variables. The Kolmogorov\u0026ndash;Smirnov test was applied to evaluate normality; means and standard deviations were calculated for parametric variables, and medians with interquartile ranges for non-parametric variables. Independent samples were analyzed using Student\u0026rsquo;s t-test or the Mann\u0026ndash;Whitney U test (for quantitative variables such as age, based on distribution of data). Qualitative variables were analyzed using Chi-square or Fisher\u0026rsquo;s exact test. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 120 patients were evaluated, with 60 patients in each group. Of the total population, 58.33% were male. The overall mean age was 37.62\u0026thinsp;\u0026plusmn;\u0026thinsp;14.75 years. In the Saline Solution (SS) Group, the mean age was 39.28\u0026thinsp;\u0026plusmn;\u0026thinsp;15.73 years, and in the Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) Group, it was 35.96\u0026thinsp;\u0026plusmn;\u0026thinsp;13.77 years, with no statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.889). The average duration of appendicitis symptoms prior to surgery was 2.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46 days, with no statistically significant difference between the two groups (p\u0026thinsp;=\u0026thinsp;0.214). The main comorbidities observed in the patients were systemic arterial hypertension (28.3%) and type 2 diabetes mellitus (27.5%). The mean BMI of the study population was 30.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.28 kg/m\u0026sup2; (obesity range). No statistically significant differences were observed between the two groups regarding these parameters (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Laboratory parameters did not show statistically significant differences between groups, except for total bilirubin (p\u0026thinsp;=\u0026thinsp;0.001), direct bilirubin (p\u0026thinsp;=\u0026thinsp;0.041), and C-reactive protein (p\u0026thinsp;=\u0026thinsp;0.030) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The average length of hospital stay overall was 4.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09 days, with a mean of 6.15\u0026thinsp;\u0026plusmn;\u0026thinsp;5.59 days in the SS Group and 1.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 days in the SISHS Group (Graph 1), demonstrating a statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.004). (Graph 1). Postoperative complications differed significantly between the two groups: seroma (p\u0026thinsp;=\u0026thinsp;0.001), abdominal wall abscess (p\u0026thinsp;=\u0026thinsp;0.01), wound infection (p\u0026thinsp;=\u0026thinsp;0.02), abdominal distension (p\u0026thinsp;=\u0026thinsp;0.002), surgical pain (p\u0026thinsp;=\u0026thinsp;0.001), postoperative ileus (p\u0026thinsp;=\u0026thinsp;0.01), and intra-abdominal abscess (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Clinical parameters after surgery also showed statistically significant differences between groups: leukocytosis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), tachycardia (p\u0026thinsp;=\u0026thinsp;0.01), tachypnea (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), hypotension (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and fever (p\u0026thinsp;=\u0026thinsp;0.006). Hypothermia did not show any statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.170) (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Descriptive Profile of Participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"287\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eSISHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eGender (M/F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eM: 70 (58.33%)F: 50 (41.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eM: 36 (60%)F: 24 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eM: 34 (56.67%)\u003c/p\u003e\n \u003cp\u003eF: 26 (43.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.312\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e37.62 \u0026plusmn; 14.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e39.28 \u0026plusmn; 15.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e35.96 \u0026plusmn; 13.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.889\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eSymptom duration (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.70 \u0026plusmn; 1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.90 \u0026plusmn; 1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.81 \u0026plusmn; 1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.214\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMedical history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eT2DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e33 (27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e18 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e15 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eSAH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e34 (28.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e14 (23.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e20 (33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1 (0.83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1 (1.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.542\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eHTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1 (1.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2 (3.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003ePWE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1 (0.83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1 (1.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30.14 \u0026plusmn; 4.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e29.43 \u0026plusmn; 4.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30.8 \u0026plusmn; 4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1. Descriptive Profile of Participants.\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003eSS: Saline Solution; SISHS: Stabilized Isotonic Sodium Hypochlorite Solution; M: Male; F: Female; T2DM: Type 2 Diabetes Mellitus; SAH: Systemic Arterial Hypertension; HIV: Human Immunodeficiency Virus; HTG: Hypertriglyceridemia; PWE: Person with Epilepsy; BMI: Body Mass Index.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Biochemical Profile of Participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"287\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003eSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eSISHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eLeukocytes (cells/\u0026mu;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e16.71 \u0026plusmn; 4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e16.14 \u0026plusmn; 4.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e17.28 \u0026plusmn; 3.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eNeutrophils (% WBC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e86.27 \u0026plusmn; 5.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e85.77 \u0026plusmn; 5.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e86.77 \u0026plusmn; 5.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eHemoglobin (g/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e14.84 \u0026plusmn; 0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e14.5 \u0026plusmn; 1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e15.19 \u0026plusmn; 1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003ePlatelets (cells/\u0026mu;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e303.5 \u0026plusmn; 70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e292 \u0026plusmn; 69.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e316 \u0026plusmn; 70.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eGlucose (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e114.4 \u0026plusmn; 46.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e121.7 \u0026plusmn; 62.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e107.14 \u0026plusmn; 30.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eCreatinine (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.86 \u0026plusmn; 0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.83 \u0026plusmn; 0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.90 \u0026plusmn; 0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eTotal Bilirubin (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.82 \u0026plusmn; 0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.72 \u0026plusmn; 0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.92 \u0026plusmn; 0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eDirect Bilirubin (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.55 \u0026plusmn; 0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.40 \u0026plusmn; 0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.7 \u0026plusmn; 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.041*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eIndirect Bilirubin (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.27 \u0026plusmn; 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.25 \u0026plusmn; 0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.30 \u0026plusmn; 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eAST (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e29.8 \u0026plusmn; 17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e27.02 \u0026plusmn; 15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e32.7 \u0026plusmn; 18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eALT (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e31.2 \u0026plusmn; 18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e28.90 \u0026plusmn; 19.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e33.5 \u0026plusmn; 18.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eSodium (mEq/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e136.5 \u0026plusmn; 3.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e136.5 \u0026plusmn; 3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e136.55 \u0026plusmn; 3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eCRP (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e61.1 \u0026plusmn; 28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e55.5 \u0026plusmn; 24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e66.8 \u0026plusmn; 31.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.030*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003ePotassium (mEq/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e3.91 \u0026plusmn; 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e3.91 \u0026plusmn; 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e3.98 \u0026plusmn; 0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2. Biochemical Profile of Participants. SS: Saline Solution; SISHS: Stabilized Isotonic Sodium Hypochlorite Solution; WBC: White Blood Cells; *: Clinically Significant Difference; AST: Aspartate Aminotransferase; ALT: Alanine Aminotransferase; CRP: C-reactive Protein.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Percentage of complications at 30 days in both groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"288\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eComplication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eSISHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eSeroma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e43 (35.83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e30 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e13 (21.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eAbdominal Wall Abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e20 (16.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e15 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e(8.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eWound\u003c/p\u003e\n \u003cp\u003eInfection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e31 (25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e22 (36.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e(15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eAbdominal Distension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e46 (38.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e32 (53.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e14 (23.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eSurgical\u003c/p\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e30 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e24 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e(10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003ePostoperative Ileus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e25 (20.83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e18 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e7 (11.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eIntra-abdominal Abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e16 (13.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e16 (26.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3. Percentage of complications at 30 days in both groups. SS: Saline Solution; SISHS: Stabilized Isotonic Sodium Hypochlorite Solution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Postoperative clinical parameters in both groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"287\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003eSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eSISHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eLeukocytosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e32 (26.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e24 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e8 (13.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eTachycardia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e25 (20.83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e18 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e7 (11.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eTachypnea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e10 (8.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e10 (16.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eHypotension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e4 (3.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4 (6.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e44 (36.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e31 (51.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e13 (21.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.006*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eHypothermia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e3 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e2 (3.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1 (1.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4. Postoperative clinical parameters in both groups. SS: Saline Solution; SISHS: Stabilized Isotonic Sodium Hypochlorite Solution\u003c/p\u003e\n\u003cp\u003eAlthough the cost of the Anasept unit was 11.4 times higher than the saline solution unit (80.00 USD versus 7.00 USD), due to the shorter hospital stay and reduced complications, the use of Anasept was associated with a 42.8% reduction in the average total cost per group (422,695.00 USD in SS group versus 241,751.00 USD in SISHS group; USD:MXN of 1.00:20.00, calculated in Nov 2024).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIntra-abdominal infections are common surgical emergencies and a frequent cause of non-traumatic hospital mortality. \u003csup\u003e27\u003c/sup\u003e Key elements for optimal management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early stabilization when necessary.\u003csup\u003e\u0026nbsp;28\u0026nbsp;\u003c/sup\u003ein general surgery he strategic use of irrigation and drain placement may be useful in some circumstances,\u003csup\u003e\u0026nbsp;29\u0026nbsp;\u003c/sup\u003edespite multiple recommendations for managing intra-abdominal infections, the use of antiseptic solutions is usually limited to surgical sites, and controversy remains due to their potential tissue toxicity. \u003csup\u003e30\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAmong the studies reviewed for this manuscript, particular attention was given to a controlled clinical trial by Anderson et al. (2020), comparing povidone-iodine irrigation versus no irrigation in patients with perforated appendicitis. The povidone-iodine irrigation was associated with fewer postoperative complications and a shorter hospital stay. However, this study focused exclusively on a pediatric population with a single pathology (perforated appendicitis). \u003csup\u003e17\u003c/sup\u003e In 2021,\u0026nbsp;Vald\u0026eacute;s-Pineda et al. associated the use of neutral-pH superoxidized electrolyzed solution (SES) with reduced complications and shorter hospital stays compared to saline irrigation and no irrigation. Although that study targeted adults, it should be noted that patients treated did not exclusively have complicated appendicitis, as the study included conditions such as gallbladder perforation, complicated diverticulitis, and even uncomplicated appendicitis. Moreover, the sample size for each group was small, unbalanced (31, 22, and 25 patients respectively), and not calculated based on statistical power, \u003csup\u003e23\u003c/sup\u003e thus predisposing to potential bias.\u003c/p\u003e\n\u003cp\u003eIn the context of laparoscopic surgery, an adult study evaluating the use of copious saline irrigation (at least 2,000 mL) combined with suction versus suction alone for complicated appendicitis found that saline irrigation was associated with a lower incidence of intra-abdominal abscesses, faster postoperative recovery, and reduced hospital costs. \u003csup\u003e25\u003c/sup\u003e In contrast, a pediatric study linked intraperitoneal saline irrigation plus suction in complicated appendicitis with prolonged hospital stay, more temperature peaks, longer surgical time, and more readmissions due to intra-abdominal collections compared to suction alone. \u003csup\u003e26\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eOur study has several strengths, including standardized pathology under evaluation (complicated appendicitis), a homogeneous adult population, a sample size greater than calculated requirements, and a comparison of the commonly used solution (saline solution). Initially, the open surgical approach was preferred over laparoscopy, as it is the procedure most frequently employed in our clinical setting.\u0026nbsp;The primary factor limiting the use of cytotoxic solutions is their potential for adverse cytotoxic effects. \u003csup\u003e14\u0026ndash;19\u003c/sup\u003e A commonly employed strategy to reduce antiseptic cytotoxicity while maintaining effectiveness is dilution. \u003csup\u003e31\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eFull-strength Dakin\u0026rsquo;s solution contains 0.5% sodium hypochlorite, and half-strength Dakin\u0026rsquo;s solution contains 0.25% sodium hypochlorite. Both solutions have demonstrated antimicrobial effects; however, their use has been limited due to cytotoxicity in fibroblasts and delayed wound healing. \u003csup\u003e32\u003c/sup\u003e In the early 1990s, it was demonstrated that a \u0026ldquo;modified Dakin\u0026rsquo;s solution\u0026rdquo; with a reduced sodium hypochlorite concentration of 0.025% retained bactericidal efficacy without cytotoxicity. \u003csup\u003e33\u003c/sup\u003e A recent study evaluated the cytotoxicity of various antiseptics on human fibroblast and keratinocyte cultures, determining that sodium hypochlorite (NaOCl) had the least detrimental effects, and therefore should be considered the least aggressive antiseptic for developing new therapeutic strategies. \u003csup\u003e34\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn 1997, Fleishmann et al. first demonstrated the benefits of combining negative pressure wound therapy (NPWT) with intermittent instillation of antiseptics or antibiotics in wounds involving exposed bone, soft tissues, and chronic wounds. \u003csup\u003e35\u003c/sup\u003e Successful use of antibiotic solutions selected according to antibiograms has been reported in complex abdominal wounds. \u003csup\u003e36\u003c/sup\u003e In abdominal sepsis, better outcomes have thus far been reported with saline solution instillation compared with negative-pressure temporary abdominal closure alone. \u003csup\u003e37\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) used in this study is commercially known as Anasept. Anasept is a modified Dakin\u0026rsquo;s solution with notable characteristics including:\u003c/p\u003e\n\u003col class=\"decimal_type\" style=\"list-style-type: upper-alpha;\"\u003e\n \u003cli\u003eIt is non-cytotoxic.\u003c/li\u003e\n \u003cli\u003eIt contains sodium hypochlorite at a concentration of 0.057%.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eIt is isotonic. \u003csup\u003e38\u003c/sup\u003e\u003c/li\u003e\n \u003cli\u003eIt demonstrates antimicrobial activity by reducing bacterial growth from high concentrations (10⁷) to undetectable levels. \u003csup\u003e39\u003c/sup\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eConsequently, its use should be considered in managing intra-abdominal infections. Notably, although the Jerusalem guidelines state in Statement 5.2 that \u0026ldquo;peritoneal irrigation does not have any advantages over suction alone in complicated appendicitis,\u0026rdquo; this conclusion is based on results obtained using saline irrigation. \u003csup\u003e40\u003c/sup\u003e The solution employed in this study has antimicrobial properties, \u003csup\u003e39\u003c/sup\u003e and recommendations for managing intra-abdominal infections emphasize adequate source control and appropriate antimicrobial therapy. \u003csup\u003e28\u003c/sup\u003e Considering concerns about potential tissue toxicity, \u003csup\u003e30\u003c/sup\u003e it is noteworthy that the solution utilized is regarded as non-cytotoxic. \u003csup\u003e38\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eComplicated appendicitis has a high rate of postoperative complications.\u003c/p\u003e\u003cp\u003eLimited high-quality evidence is available in the literature to establish an absolute consensus regarding the optimal surgical technique for complicated appendicitis.\u003c/p\u003e\u003cp\u003eThe Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) Group demonstrated greater effectiveness compared to the conventional Saline Solution (SS) Group technique.\u003c/p\u003e\u003cp\u003ePatients in the SISHS Group experienced fewer postoperative complications and shorter hospital stays following surgery.\u003c/p\u003e\u003cp\u003eThe SISHS Group also represented savings in total group care costs.\u003c/p\u003e\u003cp\u003eFurther studies are necessary to establish definitive management protocols and truly assess the effectiveness of different surgical techniques and irrigation solutions reported in the literature.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI: Body Mass Index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInc: Incorporation\u003c/p\u003e\n\u003cp\u003eiOS: iPhone Operating System\u0026nbsp;\u003c/p\u003e\n\u003cp\u003emacOS: Macintosh Operating System\u0026nbsp;\u003c/p\u003e\n\u003cp\u003emg: Milligrams \u0026nbsp;\u003c/p\u003e\n\u003cp\u003emL: Milliliters\u003c/p\u003e\n\u003cp\u003eMXN: Mexican Peso\u003c/p\u003e\n\u003cp\u003eNPWT: negative pressure wound therapy\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003en: number\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNaOCl: sodium hypochlorite\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ep: probability value\u003c/p\u003e\n\u003cp\u003epH:\u0026nbsp;potential of hydrogen\u003c/p\u003e\n\u003cp\u003eSS: Saline Solution\u003c/p\u003e\n\u003cp\u003eSES:\u0026nbsp;Superoxidation Electrolyzed Solutions\u003c/p\u003e\n\u003cp\u003eSISHS: Stabilized Isotonic Sodium Hypochlorite Solution\u003c/p\u003e\n\u003cp\u003eSPSS: Statistical Package for the Social Sciences\u003c/p\u003e\n\u003cp\u003eUSA: United States of America\u003c/p\u003e\n\u003cp\u003eUSD: United States Dollar\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements.\u0026nbsp;\u003c/strong\u003eAcknowledgment to all members of the Department of General Surgery at Hospital General de Zona No. 6, Mexican Social Security Institute (IMSS), Nuevo Le\u0026oacute;n, Mexico. We would like to express our sincere gratitude to Javier Humberto Mart\u0026iacute;nez-Garza for his invaluable inspiration, mentorship and support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions.\u0026nbsp;\u003c/strong\u003eMilton Alberto Mu\u0026ntilde;oz-Leija: Conceptualization, Project administration, Data curation, Resources, Methodology, Formal analysis, Writing-original Draft, Writing-Review \u0026amp; Editing. Marion Carolina Alem\u0026aacute;n-Jim\u0026eacute;nez: Conceptualization, Project administration, Data curation, Formal analysis, Writing- Original Draft. Ram\u0026oacute;n Gonz\u0026aacute;lez-Lemus: Project administration, Data curation, Resources, Writing-Review \u0026amp; Editing. Ra\u0026uacute;l Dario Mart\u0026iacute;nez-Carvajal: Conceptualization, Project administration, Supervision, Resources. Sa\u0026uacute;l T\u0026oacute;var-L\u0026oacute;pez: Conceptualization, Project administration, Supervision, Resources. Alejandro Quiroga-Garza: Conceptualization, Data curation, Formal Analysis, Writing - Original Draft. Armando Magdaleno Joya-Mungu\u0026iacute;a:Supervision, Data Curation, Writing - Review \u0026amp; Editing. Heliodoro Plata-\u0026Aacute;lvarez Project administration, Data curation, Resources, Writing - Review \u0026amp; Editing, Supervision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding.\u003c/strong\u003e This study didn\u0026apos;t receive any funds or grants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials.\u0026nbsp;\u003c/strong\u003eThe datasets used for the present study are available from the corresponding author (Mu\u0026ntilde;oz-Leija, [email protected]) on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to participate.\u0026nbsp;\u003c/strong\u003eThis project was evaluated and approved by the corresponding ethics committee and the corresponding research committee. Both committes assigned the approval number R-2024-1912-028.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication.\u0026nbsp;\u003c/strong\u003eWritten informed consent was obtained from all participants or their legal representatives for publication data. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests.\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCheng Y, Zhou S, Zhou R, et al. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. 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World J Emerg Surg. 2016;11(1):34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13017-016-0090-5\u003c/span\u003e\u003cspan address=\"10.1186/s13017-016-0090-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Graph","content":"\u003cp\u003eGraph 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-trauma-and-emergency-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejot","sideBox":"Learn more about [European Journal of Trauma and Emergency Surgery](http://link.springer.com/journal/68)","snPcode":"68","submissionUrl":"https://submission.nature.com/new-submission/68/3","title":"European Journal of Trauma and Emergency Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Appendicitis, Peritoneal Lavage, Saline Solution \u0026 Peritonitis","lastPublishedDoi":"10.21203/rs.3.rs-7482183/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7482183/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThere is no clear consensus on whether peritoneal lavage should be used or not, nor which solution is ideal to use, this research focused on evaluating the outcomes of using two different types of solutions and protocols for intraperitoneal lavage in adult patients diagnosed with complicated appendicitis. The sample (n=120) was divided into two groups: Saline Solution (SS) Group (n=60) which uses 2,000 mL irrigation for 3-5 minutes with subsequent excess elimination and Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) Group (n=60) which uses 443 mL irrigation for 2 minutes with subsequent suction. After performing the surgical procedure of open appendectomy, the postoperative hospital stay (total days) was evaluated along with rates of the complications (frequency and percentage) occurring within one month (30 days) after surgery. At the end the total cost of treatment was calculated for each group. Regarding postoperative hospital stay, the SISHS group required only 1.86 ± 0.6 days versus the 6.15 ± 5.59 days required by the SS group, with a statistically significant difference (p = 0.004), concerning to adverse events at 30 days, these were generally less frequent with statistically significant differences (p = 0.01 to p = 0.002) in the SISHS group compared to the SS group (with exception of hypothermia), finally the total treatment cost for the SISHS group was 42.8% cheaper compared to the SS group. These findings represent a promising therapeutic option, considering the favorable outcomes manifested by a shorter hospital stay, lower frequency of adverse events 1 month after surgery and total healthcare costs observed in the SISHS group.\u003c/p\u003e","manuscriptTitle":"Emergency Surgery Comparative Study of Saline Solution (SS) versus Stabilized Isotonic Sodium Hypochlorite Solution (SISHS) in Peritoneal Lavage in Open Appendectomy to Prevent Complications of Complicated Appendicitis in 120 Adults from México","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 13:28:11","doi":"10.21203/rs.3.rs-7482183/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-15T13:49:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-01T14:16:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48895820465487525143366931311427126673","date":"2025-10-05T19:01:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-03T13:09:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15506209398293343786873104807102605233","date":"2025-09-03T03:09:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-03T02:50:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-02T21:00:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-02T03:04:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Trauma and Emergency Surgery","date":"2025-08-28T16:25:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-trauma-and-emergency-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejot","sideBox":"Learn more about [European Journal of Trauma and Emergency Surgery](http://link.springer.com/journal/68)","snPcode":"68","submissionUrl":"https://submission.nature.com/new-submission/68/3","title":"European Journal of Trauma and Emergency Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"ce35d68c-85f1-4c82-8977-f5511dbde678","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:01:11+00:00","versionOfRecord":{"articleIdentity":"rs-7482183","link":"https://doi.org/10.1007/s00068-026-03086-8","journal":{"identity":"european-journal-of-trauma-and-emergency-surgery","isVorOnly":false,"title":"European Journal of Trauma and Emergency Surgery"},"publishedOn":"2026-02-16 15:57:42","publishedOnDateReadable":"February 16th, 2026"},"versionCreatedAt":"2025-09-09 13:28:11","video":"","vorDoi":"10.1007/s00068-026-03086-8","vorDoiUrl":"https://doi.org/10.1007/s00068-026-03086-8","workflowStages":[]},"version":"v1","identity":"rs-7482183","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7482183","identity":"rs-7482183","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}