Sonographically guided percutaneous treatment of hepatic hydatid cysts: Long-term results

Purpose. The purpose of this study was to evaluate the safety and efficacy of sonographically guided percutaneous drainage and irrigation of hepatic h ydatid cysts. Methods. Sixty-one patients with 84 hepatic hydatid cysts were treated usin g the puncture, aspiration, injection, and reaspiration (PAIR) technique un der sonographic guidance. Patients with cysts larger than 6 cm in diameter underwent PAIR followed by percutaneous drainage (PAIR-PD). The cysts were sterilized by the injection of 1 of 2 scolicidal agents, 20% hypertonic sal ine solution (38 patients) or 0.5% silver nitrate (23 patients). All patien ts underwent follow-up examinations for 1 month-6 years after aspiration. C linical and radiologic examinations and laboratory analyses were performed every month for the first 6 months and then at 3-month intervals. Results. Serial sonographic examinations revealed a heterogeneous echo patt ern in 78 cysts (93%); a progressive decrease in diameter in 76 cysts (90%) ; calcification of the cyst wall, cystic contents, or both in 10 cysts (12% ); and complete disappearance of 1 cyst (1%) in a patient who had been moni tored for over 6 years. Five patients developed urticaria, and 6 developed fever. One patient developed a biliary fistula after the first aspiration a ttempt. Two patients developed infection of the cyst cavity after PAIR-PD a nd were successfully treated with oral antibiotics. An anaphylactic reactio n developed in 2 patients and was successfully treated with antiallergenic medication. No recurrence of hydatid disease after PAIR or PAIR-PD was obse rved in any patient over the follow-up period of 72months (mean, 26 +/- 27 months). Conclusions. Percutaneous drainage of hydatid cysts is a safe, effective, a nd reliable treatment. Antiallergenic medication is required before PAIR or PAIR-PD. Both sclerosing agents, hypertonic saline and silver nitrate solu tions, gave excellent results. (C) 2000 John Wiley & Sons, Inc.