Percutaneous treatment of hepatic hydatid cysts: an alternative to surgery

Percutaneous treatment of hydatid cysts is relatively new, and the data related to it are limited. The purpose of this study was to provide additional data to strengthen the proof of its effectiveness. One hundred sixty-eight hepatic cysts in 111 patients were treated using a percutaneous approach under sonographic and fluoroscopic guidance. Cysts smaller than 5 cm in diameter were treated with a one-stage procedure that consisted of puncture of the cyst, aspiration of fluid, and injection and reaspiration of hypertonic saline solution. Larger cysts were treated with a two-stage procedure that consisted of the one-stage procedure followed by catheterization and sclerotherapy with alcohol. The mean observation time was 19 months (range, 1-48 months). Follow-up examinations showed progressive shrinkage and solidification of the cysts. Early complications occurred in 32 (28.8%) of the 111 patients, including fatal anaphylaxis in one patient, biliary fistula in seven, infection of the cyst in four, persistent serous drainage from the cyst in two, intraperitoneal leakage of cyst fluid in two, urticaria in seven, fever without evidence of infection in seven, and pleural effusion in two. Late complications occurred in four (3.8%) of the 104 patients who underwent follow-up examinations, including local recurrence in three patients and intrabiliary rupture of a cyst in one patient. Our experience indicates that percutaneous treatment is efficient in the management of hepatic hydatid cysts and that this technique should be considered an alternative to surgery.