Objective <p>To evaluate the clinical efficacy of metronidazole topical solution in preventing surgical site infections and promoting wound healing.</p> Methods <p>A comprehensive literature review was conducted using PubMed, EMBASE, Cochrane Database, and China National Knowledge Base to evaluate the impact of metronidazole topical (MS) and physiological saline rinses (SS) on infection rates and wound healing in patients with septic appendicitis after treatment. Review Manager 5.0 was utilized to evaluate the outcomes of the selected studies. The impact of the selected articles was assessed through Forest plot analysis, sensitivity analysis, and bias analysis conducted on the gathered data.</p> Results <p>Eight studies met the inclusion criteria. The results showed a significantly lower surgical site infection rate in the metronidazole (MS) group compared to the saline (SS) group (RR = 0.28, 100% CI [0.15, 0.51], <i>P</i> = 0.05, <i>I ²</i>= 59%). However, no significant difference was observed in grade I healing rates between the two groups (RR = 1.02, 100% CI [0.91, 1.15], <i>P</i> = 0.41, <i>I ²</i> = 0%). Similarly, there was a significant difference in grade II healing rates ((RR = 0.7, 100% CI [0.32, 1.55], <i>P =</i> 0.30, <i>I²</i> =5%). A significant heterogeneity was observed in grade III healing rates (RR = 0.56, 100% CI [0.17, 1.89], <i>P =</i> 0.21, <i>I²</i> =36%). Sensitivity analysis and funnel plots showed that the study was credible with limited publication bias.</p> Conclusion <p>Metronidazole topical rinse may be more effective and safer than saline rinse in treating purulent appendicitis. Local application of metronidazole to purulent appendicitis incisions is a promising approach.</p> Limitations <p>The review was not registered prospectively and some included studies had moderate bias.</p> Future directions <p>Larger multicenter trials are needed to validate the efficacy of metronidazole irrigation across diverse patient populations.</p>