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

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 povidone- iodine. 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.