PERCUTANEOUS DRAINAGE COMPARED WITH SURGERY FOR HEPATIC HYDATID CYSTS

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.