Background: Pulmonary echinococcosis is caused by the small
tapeworm Taenia echinococcus, which commonly produces hydatid cystic disease of
the liver. As hydatid cysts enlarge, they compress the surrounding parenchyma,
damaging the surrounding tissues by mechanical and toxic factors. Secondary
bacterial infections complicate the picture in 10 to 25% of cases, with either
spontaneous or traumatic rupture in 5-10% of the cases.
Objectives: A prospective randomised 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 who were admitted between 1st March
2004 through 29th February 2008, at the Unit of Chest Surgery, Hadhramout
University Hospital, Almukalla, Yemen. Group A consisted of 80 patients for
whom hydrogen peroxide was used; Group B consisted of 80 patients for whom
Povidone-Iodine, was used. Each cyst was examined both macroscopically and
microscopically to identify the effects of the used scolicidal agent on the
wall. Postoperatively, 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. Sample and data percentages, mean, and the standard deviation were
used to report data variations, using a bivariate analysis (SPSS Ltd, Quarry
Bay, Hong Kong)
Results: There was no perioperative mortality in either of
the two groups. Group A: one case of postoperative prolonged airleak 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 bronchopleural 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). The mean hospital stay was 9.6
± 1.5 days. On histologic examination of Group A, the cyst wall lost its
integrity, lustre and viability and became friable. In Group B, the cyst wall
maintained most of its lustre, integrity, and viability and did not become
friable. Moreover, microscopic examination of sections in the wall of cysts
postoperatively showed that in cysts injected with 10 % Povidone-Iodine, the
inner layer of cyst wall contained not only germinal pyknotic cells, but also
some cells with nuclear fragmentations (karyorrhexis).
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.
Statistical significance of recurrent cases among patients treated with
povidone iodine indicates that it is inferior to hydrogen peroxide in this
study. However, further research needs to be performed using higher doses of
Albendazole for much longer periods, up to several years. The study recommends
that Albendazole be administered in high doses in all cases of recurrence that
develop during the first year. The impact of this infectious disease in endemic
areas is such that continuous, focused research is warranted.
Author (s) Details
Hamdy D. Elayouty
Department of Cardiothoracic Surgery, Suez Canal University, Egypt, and
Hadhramout University, Yemen.
Ali M. Baterfy
Department of General Surgery, Faculty of Medicine, Hadhramout University,
Yemen.
Soliman H. Alkamash
Department of General Surgery, Faculty of Medicine, Suez Canal University,
Egypt.
Ahmed H.Dosoky
Suez Canal University, Egypt.
Please see the book here:- https://doi.org/10.9734/bpi/msraa/v5/5233
