Feasibility of Low-Volume Atomized Povidone-Iodine as a Peritoneal Antiseptic in Complicated Appendicitis

Abstract

Introduction

Pediatric complicated appendicitis carries significant risk of abscess formation. Current surgical techniques for reduction of postoperative abscess include suction, irrigation with saline or dilute povidone-iodine, or drain placement. However, these approaches are not supported by high-quality evidence. This study aims to investigate the feasibility of administering low-volume atomized povidone-iodine (LVAP) as an antiseptic technique for complicated appendicitis.

Materials and Methods

A retrospective case-control study of pediatric complicated appendectomies was performed at a children's hospital from 2020 to 2024. Extent of perforation was characterized as contained infection versus uncontained infection with widespread peritonitis. LVAP comprised of 5-10 cc of finely misted, nondilute povidone-iodine applied to areas of peritoneal contamination using a customized hand-powered nozzle via a standard working 5 mm trocar over approximately 15 s. Treatment was recorded as LVAP versus standard practice (suction or saline irrigation). Clinical results were compared in a stratified matching analysis.

Results

A total of 25 patients underwent LVAP and 340 underwent standard practice. Following 2:1 matching, 50 standard practice controls were included. No adverse sequelae of LVAP were noted. No statistically significant difference was detected between abscess rates following LVAP versus standard practice (16% (4/25) versus 24% (12/50), P = 0.56), though no abscesses were seen following LVAP administration for contained infection.

Conclusions

LVAP is a novel, feasible operative technique for complicated pediatric appendicitis. Though we were unable to demonstrate statistical significance, our observations of LVAP in reducing abscess rates for contained infection are promising. We are now able to estimate appropriate sample sizes needed to achieve sufficient power for a future study.