Intra-peritoneal Povidone-iodine Irrigation Decreases Abscesses in a Perforated Appendicitis Murine Model

IF 2.4 2区 医学 Q1 PEDIATRICS
Derek J. Krinock , Krista Stephenson , David Irby , Chary Akmyradov , Melanie Barker , Zachary Waldrip , Marie Burdine , Lindsey L. Wolf , Melvin S. Dassinger , Deidre Wyrick
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引用次数: 0

Abstract

Background

Children with perforated appendicitis frequently form post-operative intra-abdominal abscesses (IAA). Intra-peritoneal irrigation for prevention remains controversial. Using a perforated appendicitis murine model, we sought to determine the effect of intra-peritoneal irrigation on post-operative IAA and adhesion formation.

Methods

A survival operation was performed where cecal ligation and puncture was used to simulate perforated appendicitis. After 72 h, mice underwent a second operation where a distal cecectomy and intra-peritoneal irrigation was performed. Mice were assigned to a no irrigation group or one of four irrigation groups: normal saline, povidone-iodine (PVI), tacrolimus, or PVI followed by tacrolimus. At 2-weeks or 2-months after the second survival operation, mice were euthanized and IAAs were counted, measured, and cultured. Intra-peritoneal adhesion severity was graded on a 4-point scale. Statistical analysis compared IAA numbers and adhesion grade between the irrigation groups.

Results

In the 2-week cohort, prevalence of IAA was 78 % (n = 129). Type of irrigation solution was associated with abscess development (p < 0.001). Pairwise comparisons demonstrated PVI alone decreased abscess count. PVI irrigation caused more severe adhesions while tacrolimus decreased adhesions and adhesion grade was dependent on irrigation solution (p < 0.001). In the 2-month cohort, similar responses were observed with decreased abscess numbers in the PVI group (p = 0.006) but increased adhesion burden (p = 0.002).

Conclusion

Povidone-iodine irrigation decreases intra-abdominal abscess formation, but increases adhesion formation.

Level of Evidence

1.

Abstract Image

腹腔内聚维酮碘冲洗可减少穿孔阑尾炎小鼠模型的脓肿。
背景:儿童阑尾炎穿孔术后经常形成腹内脓肿(IAA)。腹膜内冲洗预防仍有争议。使用穿孔阑尾炎小鼠模型,我们试图确定腹膜内灌洗对术后IAA和粘连形成的影响。方法:采用盲肠结扎穿刺模拟穿孔阑尾炎,行生存手术。72小时后,小鼠进行了第二次手术,其中进行了远端盲肠切除术和腹膜内冲洗。小鼠被分配到不冲洗组或四种冲洗组中的一种:生理盐水,聚维酮碘(PVI),他克莫司,或PVI后他克莫司。在第二次生存手术后2周或2个月,对小鼠实施安乐死,并对IAAs进行计数、测量和培养。腹膜内粘连严重程度按4分制分级。统计分析灌水组间IAA数和粘附等级的差异。结果:在2周的队列中,IAA患病率为78% (n = 129)。结论:聚维酮碘冲洗可减少腹内脓肿的形成,但增加粘连的形成。证据等级:1:
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来源期刊
CiteScore
1.10
自引率
12.50%
发文量
569
审稿时长
38 days
期刊介绍: The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.
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