Abstract
Injecting scolicidal solutions into the hydatid cyst and packing the operative field with sponges soaked in scolicidal agents have been used to avoid dissemination of the parasite during surgery. In the first part of this invitro study, we tried to determine the scolicidal property of various agents in different concentrations and exposure times. In the second part, we tested whether sponges soaked in different type and concentrations of scolicidal agents have any role beyond being a mechanical barrier. 20% saline, 3% hydrogen peroxide, 1.5% cetrimide-0.15% chlorhexidine (10% Savlon®), 95% ethyl alcohol, 10% polyvinylpirrolidone-iodine (Betadine®) and their further dilutions were used in this study. Protoscoleces were obtained from the cyst containing livers of the sheep and viability was determined with dye-uptake (0.1% Eosin) and flame cell activity. Savlon® was found to be the least concentration dependent scolicidal agent among those studied. Scoleces sprayed on sponges soaked in 20% saline, 95% ethyl alcohol, Betadine® and 3% hydrogen peroxide were killed after 15 minutes. 3% and 10% saline and normal saline were ineffective. Sponges work not only as a mechanical barrier but also as a chemical one if the agent is chosen correctly. In purely cystic hydatid liver disease, the risk of dissemination of the cyst contents can be avoided by injection of a potent scolicidal agent such as Savlon®.
Highlights
Surgery is the treatment of choice for hydatid cyst of the liver since the results of medical and percutaneous treatment are still controversial
Surgery is considered the treatment of choice for hydatid disease of the liver, controversies still exist regarding the preferred operative technique, management of the residual cavity and the use of scolicidal agents
It has been traditional to inject scolicidal agents into the unopened hydatid cyst because of the risk of spillage into the peritoneal cavity leading to recurrent disease
Summary
Surgery is the treatment of choice for hydatid cyst of the liver since the results of medical and percutaneous treatment are still controversial. In the surgical management of this disease, neutralization of the parasite, evacuation of the cyst and the management of the residual cavity are the principal steps. Prevention of spillage into the peritoneal cavity and wound edges is very important. Injecting a scolicidal agent into the unopened cyst and walling off the operative field with sponges soaked in a scolicidal agent are the two most comtnonly employed measures the effectiveness of these measures is not confirmed. Hypertonic saline, cetrimide, chlorhexidine, hydrogen peroxide and ethyl alcohol are some of the compounds used as scolicidal. All are concentration dependent and their degree of dilution in the cyst contents is quite unpredictable
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