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This article presents the experience of using the modified Mannheim Peritonitis Index (MPI) score with an intraoperative assessment of the severity of peritonitis in children, taking into account the duration of the disease before surgery. Materials and Methods: We analyzed the results of treatment of 186 children under age 16 who were operated on for appendicular peritonitis in the period between 2011 and 2018. The method of scoring for appendicular peritonitis index (API) consists in summing up the points reflecting the risk factors for the disease. API provides 2 criteria for the severity of peritonitis: the first degree-API<10 points, the second degree-API≥10 points. Ten or more points are an indication for laparotomy. Results: With the definition of criteria for intraoperative assessment of the severity of peritonitis (API), the number of indications for laparotomy decreased. So, for the period from 2011 to 2014, the number of laparotomies performed with the subsequent programmed sanitation of the abdominal cavity was 17/14% cases; from 2015 to 2018, the inflammatory process in the abdominal cavity were assessed with the determination of the intraoperative index of peritonitis severity-the number of conversions was 15/11% cases.

Purpose: to select the surgical approach in appendicular peritonitis using the peritonitis index and laparoscopic intraoperative assessment of abdominal inflammation intensity.Methods and materials: experience of treating 186 patients with appendicular peritonitis is presented. Retrospective analysis of medical records of 186 patients with complicated appendicitis in 2011–2014 was performed. It was accompanied by prospective analysis substantiating the criteria for laparoscopic intraoperative assessment of the intensity of abdominal inflammatory changes in 2015 to 2018.Results. In our study, there were 98 cases (52.6%) of local peritonitis in the total structure of peritonitis (186 cases). 57 cases (30.6%) of diffuse peritonitis were observed. Among patients with acute appendicitis (1863 cases) during the examined period, local peritonitis was found in 5.2% of patients, diffuse peritonitis – in 3.05% of patients.Conclusion: criteria assessing the intraoperative severity of peritonitis enabled to decrease the rate of laparotomy from 9.1% to 6.45%.