Treatment options for hepatic cystic echinococcosis

Abstract

A number of surgical and non-surgical options exist to treat cystic echinococcosis of the liver. For decades, surgical excision via a conservative or radical approach was the recommended approach for hepatic hydatid cysts. The availability of chemotherapeutic agents with significant activity against Echinococcus granulosis has made it possible to undertake ultrasound- or computed tomography-guided transhepatic percutaneous drainage (termed puncture, aspiration, injection, and re-aspiration (PAIR)) of hydatid cysts. Pre- and post-intervention chemotherapy with albendazole or mebendazole offers the advantage of reducing the risk of disease recurrence and intraperitoneal seeding of infection that may develop via cyst rupture and spillage occurring spontaneously or during surgery or needle drainage. PAIR appears to have greater clinical efficacy (i.e. a higher incidence of cure), lower rates of major and minor complications, mortality, and disease recurrence, and fewer days of hospitalization compared to patients treated surgically. For patients who fail drug therapy alone, PAIR is a safe and effective procedure of choice for patients with hepatic echinococcosis, and perhaps other anatomic sites of infection such as lung, peritoneum, kidney, and other viscera. Surgery should be reserved for patients with hydatid cysts refractory to PAIR because of secondary bacterial infection or for those with difficult-to-manage cyst-biliary communication or obstruction.

Clinical and serological outcomes with different surgical approaches for human hepatic hydatidosis

“…Similarly, recurrence was recorded in 8 patients who underwent the PAIR technique in the present study. Although some authors state that the PAIR technique is contraindicated due to potential anaphylaxis and spillage of scolices (12) , other investigators have reported neither anaphylaxis nor dissemination with the PAIR technique (29) .…”

“…Instead of surgical removal, one recommended therapeutic procedure for hepatic hydatid cysts is the PAIR technique, which involves needle aspiration and concurrent chemotherapy (12) and satisfi es all of the surgical goals for hydatid disease by sclerosing the germinal membrane and separating the laminated membrane with scolicides (13) . However, the mainstay of therapy METHODS currently consists of well-planned surgical techniques and appropriate procedures based on the correct evaluation of disease complications and performed by an experienced team, with adequate postoperative support (14) .…”

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.…”

“…[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. [2,3,7,12] Conservative therapies are simple and safe procedures but comparing to radical one post operative complications, recurrence and hospital stay time are higher. [12][13][14][15] In this study 135 patients with hydatid cyst have been retrospectively evaluated during 10 years of experience and the outcomes of different techniques have been compared to see if the radical therapy has less complications and recurrence.…”

Clinical and Serological Outcomes in Different Surgical Approaches for Hepatic Human Hydatidosis

“…Several factors affect the preference of therapeutic surgical approach including number and localization of the cysts, surgeon expertise and presence of complications. One of the recommended therapeutic procedures for hepatic hydatid cysts is needle aspiration and concurrent chemotherapy known as the PAIR procedure to be done instead of surgical removal [9,12]. The PAIR procedure is recorded to satisfy all the goals of surgery for hydatid disease by sclerosing germinal membrane and separating laminated membrane with scolicides [13].…”