Efficacy of daikenchuto after laparoscopic surgery for perforated appendicitis

Background: Although many recent studies have scientifically verified the efficacy of the traditional herbal medicine daikenchuto (DKT) for postoperative gastrointestinal function, its efficacy has not been established in children. We retrospectively evaluated the effect of DKT in pediatric patients with panperitonitis associated with perforated appendicitis (PaPA) who underwent laparoscopic appendectomy. Methods: Among 34 children with PaPA who underwent laparoscopic appendectomy from May 2012 to May 2021, 19 received DKT (group D) and 12 did not (group C). We compared postoperative gastrointestinal function, complications, and improvement in the inflammatory response between the two groups. Results: Of the evaluation parameters for postoperative gastrointestinal function, the mean +/- standard deviation time to first flatus was significantly shorter in group D than in group C (1.21 +/- 0.42 and 2.17 +/- 0.94 days respectively; p = 0.0005). The time to ingestion of half a meal was also significantly shorter in group D than in group C (8.42 +/- 3.69 and 12.50 +/- 4.96 meal occasions respectively; p = 0.01). There was no significant difference in complication rates between the two groups. Conclusion: Daikenchuto rapidly and safely improved postoperative gastrointestinal symptoms in children with PaPA. To the best of our knowledge, this is the first study to evaluate the effect of DKT on postoperative symptoms in laparoscopic appendectomy and in children.