Dr. Krysta Sutyak - Best of the Best in Pediatric Surgery 2025

Appendicitis is the most common diagnosis requiring urgent surgical treatment in the pediatric population.

34% of almost 34,000 children who underwent appendectomy in the United States from 2019 to 2021 were found to have perforation.

Perforated appendicitis increases the risk for post-operative intraabdominal abscess with 10 to 30% of patients with perforation developing an abscess.

At their institution from 2013 to 2019, development of post-operative abscess was associated with a length of stay increase of 6.1 days and an estimated incremental cost increase of $11,809 US per patient.

Providone iodine has bactericidal properties, matching the pathogen profile seen most commonly in perforated appendicitis and abscess formation.

In the 2016 pilot RCT, patients in the intervention arm received irrigation of the right lower quadrant and pelvis with PVI solution containing 0.1% available iodine compared to usual care in the control arm.

The 2016 trial resulted in an 89% probability that PVI reduced the rate of abscess and a 96% probability of decreased length of stay.

In secondary cost analysis of the 2016 trial, there was a mean cost difference between the PVI group and usual care group of $1,954 US, reflecting a 95% based in probability of reduced 30-day hospital costs.

For all 50 participants in the 2016 trial, this was an estimated hospital cost savings of $98,000.

Theoretical concerns about PVI use intraabdominally include potential adhesive disease, gastrointestinal effects or thyroid dysfunction.

Of the 100 trial participants reviewed, 60% were male with a median age at the time of surgery of 9.5 years.

51% of trial participants had subsequent encounters within the electronic medical record, including 50% of those who received PVI therapy and 52% of those who received usual care.

The median follow-up time was 7.3 years.

Only seven of the 100 patients had an ED visit related to their appendicitis diagnosis with five in the usual care group and two in the PVI group.

Three patients had a related readmission, all from the usual care group.

Zero patients were identified as being diagnosed with chronic abdominal pain, diarrhea or small bowel obstruction.

Five patients had encounters related to constipation with one from the usual care group and four from the PVI group.

Two patients were identified as having thyroid related diagnosis since the time of surgery.

For the most part the usual care in the trial was no irrigation, though it was defined as usual care within their practice.

One patient from the PVI group was diagnosed with thyroiditis after positive TPO antibodies were identified in the initial screening for the trial, which was determined by pediatric endocrinology to be unrelated to the PVI use.

One patient from the usual care group was diagnosed with papillary thyroid carcinoma 7.5 years later at the age of 22.

Children after PVI irrigation for perforated appendicitis did not demonstrate any adverse events, unexpected outcomes or differences in rates of biologically plausible conditions related to PVI.

A major limitation of the safety study is the retrospective nature and that data was only available for 50% of patients, though this was equal between groups.

Both thyroid conditions identified were unrelated to the use of PVI.