Intracystic pressure and viability in hydatid disease of the liver

Background: Knowledge on the viability of hydatid cysts of the liver during operation is important to the surgeon may dictate the peri-operative thera peutic manoeuvre undertaken. Patients and Methods: A prospective study was performed on 23 patients with 28 hydatid cysts of the liver to assess whether intracystic pressure (ICP) could predict viability of protoscoleces. All patients received albendazol e (10 mg/kg body weight/day) for 5 days pre-operatively. The ICP was measur ed from the apex of the cyst, after laparotomy, using a 16-G needle connect ed to a water manometer. After manometry, the cyst contents were aspirated and the viability of protoscoleces assessed by their flame cell activity, m otility and ability to exclude 5% aqueous eosin. Results: The median ICP was 54 +/- 21 cmH(2)O for 17 viable cysts and zero for 8 non-viable cysts, while 1 additional non-viable cyst and 2 sterilized cysts had high ICP (sensitivity, 100%; specificity, 72%; accuracy, 89%). T he median diameter of the viable cysts was 9.3 +/- 3.5 cm and the non-viabl e cysts 10.7 +/- 2.6 cm. In the right lobe were located 12 viable and 8 non -viable cysts and in the left lobe, 5 viable and 3 non-viable cysts. No sig nificant difference in diameter or ICP were noted between the hepatic lobes . Conclusions: These findings suggest that the measurement of ICP is a simple , cheap and reliable method for assessment of the viability of hydatid cyst s of the liver.