Is the Intraoperative Use of the Chlorhexidine Gluconate Safe for Inactivation of the Liver Hydatid Cyst?

During surgical treatment of hydatidosis, spillage of live protoscolices is a major cause of secondary infection. Although some studies have suggested scolicidal agents for preventing secondary infection, no safe scolicidal agents have been introduced so far.

This study aimed to determine the minimum scolicidal concentration of chlorhexidine gluconate (Chx-Glu) with 100% fatality and evaluate its toxicity on the liver, biliary tract, and peritoneum.

The minimum scolicidal concentration of Chx-Glu after 5 and 10 minutes in vitro (0.08% after 5 and 0.06% after 10 min) was determined in this study. Then, the experiments were conducted on male New Zealand rabbits (n=30), which were divided into two groups. Under the guidance of ultrasonography, intraperitoneal, hepatic parenchyma, and gallbladder injection of Chx-Glu 0.08% and 0.06% were performed in groups A and B, respectively. Liver enzymes were checked before and 48 hours after Chx-Glu injection, and histological assessments were performed 45 days later.

There was no significant difference in the plasma levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin before and after the injection (P > 0.05) and after that between the two groups (P > 0.05). There was no major tissue destruction based on histological study except the nonsignificant histologically focal gallbladder mucosal atrophy in two rabbits in group A and one in group B.

Our study suggests that Chx-Glu at 0.06 - 0.08 % is a safe scolicidal agent without major tissue toxicity in the animal models that can be used to prevent secondary infection during hydatid cyst surgery.