Percutaneous treatment of univesicular versus multivesicular hepatic hydatid cysts E. Zerem, R. Jusufovic The Interventional Ultrasonography Department, University Clinical Center, Tuzla, Bosnia and Herzegovina Received: 21 February 2006/Accepted: 30 April 2006/Online publication: 1 August 2006 Abstract Background: Percutaneous drainage has been used suc- cessfully to treat hepatic hydatid cysts. This study aimed to analyze the results of this method in the treatment of univesicular and multivesicular hepatic hydatid cysts. Methods: Ultrasound-guided percutaneous drainage was used to treat 72 patients (44 women and 28 men; average age, 46.8 ± 17.7 years) with hepatic hydatido- sis. Of these 72 patients, 57 had one cyst, 7 had two cysts, and 8 had three cysts. Albendazole (10 mg per kg of body weight daily for 8 weeks) was administered to all the patients. Serial assessments included clinical and biochemical examinations, ultrasonography, and sero- logic tests for echinococcal antibody titers. Results: During the follow-up period, the mean cyst diameter decreased from 83.3 ± 38.6 mm to 11.1 ± 16.0 mm (p < 0.001) in the multivesicular group (27 cysts) and from 65.5 ± 27.5 to 5.9 ± 13.0 mm (p < 0.001) in the univesicular group (68 cysts). The final cyst diameter did not differ significantly between the two groups (p = 0.1). The findings showed that 81% of the cysts in the univesicular group and 63% in the multive- sicular group disappeared (p = 0.12). The mean hos- pital stay was 4.8 ± 2.9 days in the univesicular group and 6.1 ± 4.7 days in the multivesicular group (p < 0.001). After an initial rise, the echinococcal-antibody titers fell progressively, and at the last follow-up evalu- ation were negative (<1:160) for 43 patients (94%) in the univesicular group and 19 patients (73%) in the mul- tivesicular group (p = 0.03). Mild nonfatal complica- tions were experienced by 24 patients (33%). Conclusions: Percutaneous drainage combined with albendazole therapy is an effective and safe method for managing hydatid cysts of the liver that requires a short hospital stay. Disappearance of the cysts depends on cyst size. Multivesicular cysts have a more complicated course, a slower disappearance, and a higher incidence of positive echinococcal-antibody titers. Abscess formed after the procedure can be treated successfully by per- cutaneous drainage. Key words: Hepatic hydatid cyst — Interventional ultrasound — Percutaneous drainage Hydatid disease caused by Echinococcus granulosus ex- ists in endemic cattle- and sheep-raising areas of Central Europe, the Mediterranean countries, the Middle East, South America, Australia, New Zealand, and South Africa. Human infection is acquired by ingesting the parasite eggs from infected animals. Infestation by hydatid disease in humans most commonly occurs in the liver (55–70%) or the lung (18–35%), and less frequently in the spleen, kidneys, heart, brain, pancreas, uterus, and muscles. Echinococcus usually is asymptomatic, but may cause morbidity and occasional mortality [1–3]. The ultimate goal of treatment is to eliminate the germinal layer of the hydatid cyst. Currently, three treatment options are available: surgery, medical treat- ment, and percutaneous drainage [4, 5]. Surgery, the only treatment option available until the mid 1980s, still is performed. Radical surgical resection [6–9] or lapa- roscopic cystectomy can be performed [10–13]. Medical treatment alone with benzimidazoles (mebendasole and albendasole) leads to a scolicidal effect, but its success rate has varied from 0% to 88% in different studies [14– 16]. Preoperative prophylaxis with benzimidazoles is commonly advised, although there are no published data establishing its efficacy [5, 16]. A percutaneous treatment known as PAIR (punc- ture, aspiration, injection, reaspiration) is a minimally invasive and very effective treatment for hydatidosis. As compared with surgery, PAIR is a simpler, less invasive procedure, with low complication, recurrence, and mortality rates [17–20]. A prospective study of PAIR used to manage hepatic hydatid cysts examined the differences and similarities between univesicular and multivesicular cysts during treatment and follow-up Correspondence to: E. Zerem Surg Endosc (2006) 20: 1543–1547 DOI: 10.1007/s00464-006-0135-z Ó Springer Science+Business Media, Inc. 2006