Hydrogen Peroxide Versus Povidone Iodine as Intra-Operative Scolicidal Agents to Attack Hydatid Cysts

Abstract

Objectives: A prospective randomized study designed to compare results of intra-operative applications of povidone-iodine with those of hydrogen peroxide during surgery for hydatid cysts. Methods: This study includes 160 patients with pulmonary and/or hepatic univesicular hydatid cysts. Group A consisted of 80 patients for whom we used hydrogen peroxide; Group B consisted of 80 patients for whom we used povidoneiodine. Each cyst was examined both macroscopically and microscopically to identify effects of the used scolicidal agent on the wall. Post-operatively, patients received Albendazole as a scolicidal drug for one year. Follow up times ranged between 48 and 84 months. Chest x-rays and abdominal ultrasound examinations were performed every six months to detect any recurrences. Results: There was no peri-operative mortality in either of the two groups. Group A: one case of postoperative prolonged air-leak and two cases of wound infection. No recurrences were reported. Mean hospital stay was 5.5 ± 1.1 days. Group B: two cases of prolonged air leak, three cases of persistent cough and hemoptysis, one developing broncho-pleural fistula that healed (air leak ceased after 19 days), two cases of wound infection, one had subphrenic abscess, nine cases of recurrences, one on the diaphragmatic pleura, two with deep chest wall cysts at sites of thoracostomy tubes, four intraperitonial recurrences, two in the same liver lobe. Recurrences occurred in 11% of the subjects (9/80; p value = 0.028). Mean hospital stay was 9.6 ± 1.5 days. On histologic examination of Group A, the cyst wall lost its integrity, luster and viability and became friable. In Group B the cyst wall maintained most of its luster, integrity, viability and did not become friable. Conclusions: Hydrogen peroxide is a more effective and safer scolicidal drug than povidone-iodine as shown by the differences in mean duration of hospital stay and postoperative recurrence rate significance.

Primary Hydatid Cyst of the Thigh: Atypical Location and Perioperative Strategies to Minimize Recurrence After Accidental Cyst Rupture

“…Surgical excision remains the preferred treatment method, and postoperative antihelminthic therapy (albendazole) is administered to prevent recurrence [14,15]. Intraoperative safety precautions involve using fields of hypertonic saline or hydrogen peroxide applied to the wound borders to reduce the risk of recurrence [16][17][18][19]. Local recurrence rates may vary, and in cases with inadequate surgical margins or intraoperative cyst rupture, as seen in this case, they could be as high as 12.4% [20].…”

In vitro activity of antiseptic solutions against Madurella mycetomatis : implications for eumycetoma management

“…10 In contrast, H 2 O 2 is a U.S. Food and Drug Administration generally recognized as safe antiseptic. 9 Based on reports in the literature and the in vitro data reported herein, it is clear that only a clinical trial will answer the question of which antiseptic solution for use in lavage of the surgical field after removal of mycetoma grains and in dressing postoperative wounds will result in fewer recurrent infections. …”

“…8 In contrast, in echinococcosis -another infection in which surgery is used to remove the infectious agent -rinsing the surgical field after removal of Taenia cysts from the lung or liver with hydrogen peroxide resulted in significantly fewer recurrent infections and a significantly shorter stay in hospital compared with rinsing with povidone iodine. 9 As well as being more effective in cleaning a wound, the safety of an antiseptic solution also plays a role. Taurolidine not only has antiseptic properties, but it is also known to inhibit certain cytokines and angiogenesis.…”

Laparoscopic deroofing of recurrent giant echinococcal and simple liver cysts in Uganda: a case series

“…Their accurate diagnosis and management are important given their higher estimated mortality of 2%-5% [1] . Management of echinococcal liver cysts is aimed at inactivation of scolocides by scolicidal agents such as hypertonic saline (20% NaCl), 3% hydrogen peroxide, benzimidazoles, 10% povidone-iodine and 95% alcohol, removal of the cyst contents without spillage, and appropriate management of the remaining cavity [10,11] .…”