title: Povidone-iodine vs sodium hypochlorite enema for mechanical preparation before elective open colonic or rectal resection with primary anastomosis: a multicenter randomized controlled trial.
abstract: OBJECTIVE
  The anti-infective actions of povidone-iodine (PVI) and sodium hypochlorite enemas are different.
  
  
  METHODS
  Prospective, randomized, single-blind study.
  
  
  METHODS
  Multicenter.
  
  
  METHODS
  Five hundred seventeen consecutive patients with colorectal carcinoma or sigmoid diverticular disease undergoing elective open colorectal resection, followed by primary anastomosis.
  
  
  METHODS
  All patients received senna (1-2 packages diluted in a glass of water) at 6 pm the evening before surgery. Patients were administered two 2-L aqueous enemas of 5% PVI (n = 277) or 0.3% sodium hypochlorite (n = 240) at 9 pm the evening before surgery and at 3 hours before operation. Intravenous ceftriaxone sodium (1 g) and metronidazole (1 g) were administered at anesthetic induction.
  
  
  METHODS
  Rate of patients with 1 infective parietoabdominal complication or more.
  
  
  RESULTS
  The percentages of patients with 1 infective parietoabdominal complication or more did not differ between the 2 groups (13.7% in the PVI-treated group vs 15.0% in the sodium hypochlorite-treated group). Tolerance was better in the PVI-treated group than in the sodium hypochlorite-treated group (79.4% vs 67.9%), with fewer patients experiencing abdominal pain (13.0% vs 24.6%) or discontinuing their preparation (3.0% vs 9.0%) (P=.02 for all). There were more patients with malaise in the PVI-treated group than in the sodium hypochlorite-treated group (9.1% vs 4.9%, P<.05). Three patients in the sodium hypochlorite-treated group had necrotic ulcerative colitis.
  
  
  CONCLUSIONS
  When antiseptic enemas are chosen for mechanical preparation before colorectal surgery, PVI should be preferred over sodium hypochlorite because of better tolerance and avoidance of necrotic ulcerative colitis.
authors.affiliation: Surgical Unit, Hôpital Louis Mourier (Assistance Publique-Hôpitaux de Paris), Colombes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Valverde
authors.forename: Simon
authors.initials: S
authors.lastname: Msika
authors.forename: Reza
authors.initials: R
authors.lastname: Kianmanesh
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Hay
authors.forename: Anne-Cécile
authors.initials: AC
authors.lastname: Couchard
authors.forename: Yves
authors.initials: Y
authors.lastname: Flamant
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
authors.forename: Pierre-Louis
authors.initials: PL
authors.lastname: Fagniez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D004202:Disinfectants / Q000008:administration & dosage*; D004241:Diverticulum, Colon / Q000601:surgery*; D017558:Elective Surgical Procedures; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011206:Povidone-Iodine / Q000008:administration & dosage*; D011300:Preoperative Care; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D012810:Sigmoid Diseases / Q000601:surgery*; D016037:Single-Blind Method; D012973:Sodium Hypochlorite / Q000008:administration & dosage*
chemical_list: D000891:Anti-Infective Agents, Local; D004202:Disinfectants; D011206:Povidone-Iodine; D012973:Sodium Hypochlorite