Treatment of Hydatid Cyst of the Liver: Where Is the Evidence?

Abstract

Treatment of hydatid cyst of the liver ranges from surgical intervention (conventional or laparoscopic approach) to percutaneous drainage and to medical therapy. The aim of this systematic review was to provide "evidence-based" answers to the following questions: Should chemotherapy be used alone or in association with surgery? What is the best surgical technique? When is the percutaneous aspiration injection and reaspiration technique (PAIR) indicated? An extensive electronic search of the relevant literature without limiting it to the English language was carried out using MEDLINE and the Cochrane Library. Key words used for the final search were "hydatid cyst," "liver," "treatment," "meta analysis," "randomized controlled trial," "prospective study," "retrospective study." All relevant studies reporting the assessment of one modality of treatment or a comparison of two or several therapeutic methods to treat hydatid cyst of the liver and published in a peer-reviewed journal were considered for analysis. This systematic review allowed us to conclude that chemotherapy is not the ideal treatment for uncomplicated hydatid cysts of the liver when used alone (level II evidence, grade B recommendation). The level of evidence was too low to help decide between radical or conservative treatment (level IV evidence, grade C recommendation). Omentoplasty associated with radical or conservative treatment is efficient in preventing deep abscesses (level II evidence, grade A recommendation). The laparoscopic approach is safe (level IV evidence, grade C recommendation). Drug treatment associated with surgery (level II evidence, grade C recommendation) requires further studies. Percutaneous drainage associated with albendazole therapy is safe and efficient in selected patients (level II evidence, grade B recommendation). The level of evidence is low concerning treatment of complicated cysts.

Study of the Radical vs. Conservative Surgical Treatment of the Hepatic Hydatid Cyst: A 10-Year Experience

“…Traveling and tourism has change its pattern to a wide spread disease even in developed countries. [1][2][3][4] Hydatid cyst has been treated using medical treatment and cutaneous drainage and surgery, [5][6][7][8] but the main treatment has been surgery using different techniques which generally is divided in two subgroups; radical one and conservative. [9][10][11] Using conservative procedure, the cyst would be drained out without omitting the pericystial layer; while radical procedure focuses on removing all the cyst layers as well as percystial one.…”

Profile of patients with hepatic hydatid disease not treated surgically

“…In contrast, the difficulty of predicting long-term prognosis and the possibility of developing complications due to cyst growth, some of which may be life-threatening, suggests that asymptomatic young patients should be treated (3). At present, patients with asymptomatic cysts can be managed in different ways: no treatment (watch-and-see policy) or treatment with albendazole, PAIR or surgery (3)(4)(5)8). Each option is briefly summarized below.…”

“…Despite the large number of patients with HHD, the level of evidence on which therapeutic decisions are based is low (2,4,6). While it can be claimed that the mainstay of HHD treatment is surgery, especially when complications exist, other therapeutic options exist, such as pharmacologic treatment with albendazole or cyst puncture with the PAIR technique, an acronym for puncture, aspiration, instillation and re-aspiration, which has become popular for the management of uncomplicated cysts (1,4).…”

“…Hepatic hydatid disease (HHD) is endemic in certain areas of the planet and is caused by parasites of the genus Echinococcus (1)(2)(3)(4)(5). Despite the large number of patients with HHD, the level of evidence on which therapeutic decisions are based is low (2,4,6).…”

Hydatid cyst of liver: different modalities of management and outcome

“…Man is an accidental intermediate host in the evolution of this parasite. 1 It is still an important health problem in our country, which is an endemic area for the infection. It has a variety of courses, sometimes even remaining asymptomatic for years, and diagnosed only incidentally using screening methods.…”