Hydatid cysts of the liver: long-term results of percutaneous treatment using a cutting instrument.

OBJECTIVE

We previously reported a technique for percutaneous drainage of hydatid cysts of the liver using a cutting instrument. The purpose of this study was to review the efficacy of this procedure in a large series of patients.

SUBJECTS AND METHODS

The study included 32 patients each with a single hydatid cyst of the liver. Sixteen cysts were univesicular, nine were multivesicular, and four had a ruptured membrane. Two were infected, and one was calcified. Using a coaxial system, a large-bore cutting aspiration device was percutaneously introduced. Initial success consisted of complete evacuation of cyst contents plus absence of laminated membranes and daughter cysts on a cystogram performed 2 weeks later. Catheter drainage was continued until it was < 20 ml/day (mean, 4 weeks; median, 3 weeks). Patients underwent clinical and imaging follow-up examinations for between 9 and 48 months (mean, 25.5 months; median, 20 months). Follow-up imaging included monthly sonographic examinations for 6 months, control CT at 6 months, and sonographic and CT studies at 1-year intervals. All complications were recorded.

RESULTS

A single aspiration and drainage procedure removed the liquid and solid cyst contents in 90% of the patients. Minor complications were limited to transient vasovagal reaction, mild fever that cleared without antibiotics, and reactive pleural effusion (19%). Three patients (10%) required a second intervention either to evacuate residual laminated membrane or to drain an abscess that developed within an incompletely evacuated cyst (one case). Eleven patients had bile in the drainage fluid. A biliary fistula was seen in five of those. No sign of recurrence was observed. Complete obliteration of the cavity was observed within six months in all cases. Complete reconstitution of hepatic parenchyma was shown by either sonographic or CT examinations within 1 year in 21 cases (66%).

CONCLUSION

Results in a large group of patients indicate that the treatment of hydatid liver cysts with a cutting aspiration device is safe, effective, and reliable. It provides a high incidence (90%) of initial success with a low incidence of major complications (3%). Long-term follow-up has demonstrated no recurrence in the follow-up period.