Povidone-iodine vs sodium hypochlorite enema for mechanical preparation before elective open colonic or rectal resection with primary anastomosis: a multicenter randomized controlled trial.
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.
Valverde
Alain
A
Surgical Unit, Hôpital Louis Mourier (Assistance Publique-Hôpitaux de Paris), Colombes, France.
Msika
Simon
S
Kianmanesh
Reza
R
Hay
Jean-Marie
JM
Couchard
Anne-Cécile
AC
Flamant
Yves
Y
Fingerhut
Abe
A
Fagniez
Pierre-Louis
PL
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*
D000891:Anti-Infective Agents, Local; D004202:Disinfectants; D011206:Povidone-Iodine; D012973:Sodium Hypochlorite