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

Background: 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. Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.