Percutaneous treatment of hydatid cysts of the liver: Long-term results

OBJECTIVE. The purpose of the study was to present the long-term results of percutaneous treatment of liver hydatid cysts. SUBJECTS AND METHODS, Seventy-two patients (44 male and 28 female, ranging in age between 10 and 69 years; mean age, 35 years) with 106 liver hydatid cysts underwent percutaneous treatment with albendazole prophylaxis. Punctu re, aspiration, injection, and reaspiration (PAIR) were used for hydatid cy sts smaller than 6 cm (n = 66). Larger cysts (n = 40) were treated by cathe terization. Hypertonic saline solution and absolute alcohol were used as th e cytotoxic and sclerosing agents. Sonographic guidance with or without flu oroscopy was used in all patients. Follow-up was mainly by sonography every third month of the first year, every sixth month of the second year, and o nce a year thereafter. The mean followup time was 37 months. RESULTS. The mean reduction in volume at the time of the first follow-up wa s 87.0% and 73.5% in catheterization and PAIR patients, respectively. The i mmediate sonographic changes after treatment were detachment of the endocys t and disappearance of the regular endocyst, with a reduction in the fluid component. The solid appearance of the cyst remnant indicated complete cure as the cyst wall became irregular and thicker. The average time for develo pment of a solid appearance was 19 months in PAIR patients and 26 months in catheterization patients. Seventy of 72 patients were cured, whereas two r ecurrences (2.8%) were observed. No mortality, abdominal dissemination, or tract seeding occurred. Minor complications were urticaria and fever in eig ht patients (11.1%). Major complications were infection of the cyst cavity in two patients (2.8%) and development of biliary fistula in four patients (5.6%). Mean hospitalization times were 17 days for complicated cases and 1 day for uncomplicated cases. CONCLUSION, The long-term results of percutaneous liver hydatid cyst treatm ent accord with shea-term results, indicating that the procedure is efficie nt and safe and offers complete cure in selected patients with a short hosp italization.