Ms. Khuroo et al., PERCUTANEOUS DRAINAGE COMPARED WITH SURGERY FOR HEPATIC HYDATID CYSTS, The New England journal of medicine, 337(13), 1997, pp. 881-887
Background In recent years percutaneous drainage has been used success
fully to treat the hepatic hydatid cysts of echinococcal disease. We p
erformed a controlled trial to compare the safety and efficacy of perc
utaneous drainage with those of surgical cystectomy, the traditional t
reatment. Methods In a prospective study, we randomly assigned 50 pati
ents with hepatic hydatidosis to treatment with percutaneous drainage
(25 patients) or cystectomy (25). Albendazole (10 mg per kilogram of b
ody weight per day for eight weeks) was administered to the patients w
ho underwent percutaneous drainage. Serial assessments included clinic
al and biochemical examinations, ultrasonography, and serologic tests
of echinococcal-antibody titers. Results The mean (+/-SD) hospital sta
y was 4.2+/-1.5 days in the drainage group and 12.7+/-6.5 days in the
surgery group (P<0.001). Over a mean follow-up period of 17 months, th
e mean cyst diameter decreased from 8.0+/-3.0 to 1.4+/-3.5 cm (P<0.001
) after percutaneous drainage and from 9.1+/-3.0 to 0.9+/-1.8 cm (P<0.
001) after surgery. The final cyst diameter did not differ significant
ly between the two groups (P=0.20). The cysts disappeared in 22 patien
ts (88 percent) in the drainage group and in 18 (72 percent) in the su
rgery group (P=0.29). After an initial rise, the echinococcal-antibody
titers fell progressively and at the last follow-up were negative (<1
:160) in 19 patients (76 percent) in the drainage group and 17 (68 per
cent) in the surgery group (P=0.74). There were procedure-related comp
lications in 8 patients (32 percent) in the drainage group and 21 (84
percent) in the surgery group, 17 of whom had fever postoperatively (P
<0.001). Conclusions Percutaneous drainage, combined with albendazole
therapy, is an effective and safe alternative to surgery for the treat
ment of uncomplicated hydatid cysts of the liver and requires a shorte
r hospital stay. (C) 1997, Massachusetts Medical Society.