Percutaneous treatment of univesicular versus multivesicular hepatic hydatid cysts

Abstract

Background: Percutaneous drainage has been used successfully 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 hydatidosis. 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 serologic 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 multivesicular group disappeared (p = 0.12). The mean hospital 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 evaluation were negative (<1:160) for 43 patients (94%) in the univesicular group and 19 patients (73%) in the multivesicular group (p = 0.03). Mild nonfatal complications 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 percutaneous drainage.