DOI: https://doi.org/10.36347/sjams.2025.v13i12.011

Pages: 2016-2021

Background: Laparotomy for dirty abdominal surgeries in children under five years poses significant clinical challenges due to gross contamination and high risk of postoperative complications. Infants and neonates are particularly vulnerable because of immature immunity, limited physiological reserves, and higher susceptibility to sepsis and peritonitis. Objective: This study aimed to assess the clinical outcomes of children up to five years undergoing laparotomy for dirty surgeries and to evaluate the impact of intraperitoneal gentamicin lavage on postoperative recovery. Methods: A randomized controlled trial was conducted at the Faculty of Pediatric Surgery, Bangladesh Shishu Hospital and Institute, Dhaka, from March 2018 to December 2019. Seventy children undergoing dirty laparotomy were enrolled and randomized into two groups: Group A (n=35) received intraperitoneal lavage with gentamicin in saline, and Group B (n=35) received saline alone. Data collected included demographic parameters, type of disease, peritoneal fluid culture results, postoperative complications, wound infection, wound dehiscence, secondary suturing, and hospital stay. Statistical analysis was performed using SPSS 23.0, with significance set at p<0.05. Results: The majority of subjects were infants aged 1–12 months (65.7% in Group A, 51.4% in Group B). Neonates accounted for 14.3% in Group A and 20% in Group B. Mean weight was 6.1 ± 0.19 kg in Group A and 4.31 ± 0.72 kg in Group B (p>0.05). Common diagnoses included midgut volvulus and ileal perforation in neonates, intussusception in infants, and appendicular or ileal perforation in older children. Peritoneal cultures were predominantly sterile (88.6% in Group A vs. 80% in Group B), with E. coli and Klebsiella as the most frequent isolates. While culture positivity did not differ significantly, children in the gentamicin group experienced reduced postoperative fever, lower surgical site infection rates, and shorter hospital stays compared to