How is surgery performed for the treatment of cystic echinococcosis (CE)?

Updated: May 07, 2019
  • Author: Imad S Dandan, MD; Chief Editor: BS Anand, MD  more...
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Answer

Description of surgical procedure

The basic steps of the procedure are eradication of the parasite by mechanical removal, sterilization of the cyst cavity by injection of a scolicidal agent, and protection of the surrounding tissues and cavities.

Scolicidal agents include formalin, hydrogen peroxide, hypertonic saline, chlorhexidine, absolute alcohol, and cetrimide. A variety of complications have been described with all scolicidal agents, but in the authors' experience, 0.5% cetrimide solution provides the best protection with the least complications. Other scolicidal agents are 70%-95% ethanol and 15%-20% hypertonic saline solutions. A report by Ochieng'-Mitula and Burt in 1996 on the injection of ivermectin in the hydatid cysts of infected gerbils revealed several damaged cysts with no viable protoscoleces. [10] Further evaluation of this scolicidal agent is needed.

At surgery, the exact location of the cyst is identified and correlated with the radiologic findings. The surrounding tissues are protected by covering them with cetrimide-soaked pads. The cyst is then evacuated using a strong suction device, and cetrimide is injected into the cavity. This procedure is repeated until the return is completely clear. Cetrimide is instilled and allowed to sit for 10 minutes, after which it is evacuated, and the cavity is irrigated with isotonic sodium chloride solution. This ensures both mechanical and chemical evacuation and destruction of all cyst contents. During this process, care is taken to ensure no spillage occurs to prevent seeding and secondary infestation.

The cavity is then filled with isotonic sodium chloride solution and closed. Rarely, the omentum is needed to fill the cavity. The cyst fluid is inspected for bile staining at the end of the evacuation and irrigation process. The inside of the cyst is inspected, and any bile duct communication is sutured. In case of infected cysts with biliary communication, closed suction drainage is required. Regardless of whether an open or a laparoscopic approach is chosen, these basic principles must be followed in order to ensure the safety of the procedure.


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