ABSTRACT
To compare the safety and efficacy of percutaneous drainage with those of surgical cystectomy, the traditional treatment of hydatid disease of the liver. In a prospective study, we randomly assigned patients with hepatic hydatidosis Gharbi types I, II and III to treatment with ultrasound guided percutaneous drainage [16 patients] and cystectomy [15 patients]. Albendazole [10 mg per kilogram of body weight per day for eight weeks] was administered to the patients of both groups. Patients were serially assessed by clinical and ultrasonographic examinations, and hydatid serologic tests. The cyst diameter did not differ significantly between the two groups [P= 0.20]. At 6 month follow-up, the mean cyst diameter decreased from 10.4 +/- 3.7 to 3.4 +/- 1.5 cm [P<0.001] after percutaneous drainage and from 9.4 +/- 4.1 to 1.8 +/- 0.9 cm [P<0.OOl] after surgery. The mean hospital stay was 6.2 +/- 1.2 days in the drainage group and 12.4 +/- 3.5 days in the surgery group [P<0.00l]. Over a mean follow-up period of 12 +/- 3 months in the drainage group and 10 +/- 2 months in the surgery group, complete cyst healing [sonographically evidenced cyst death] occurred in all patients of both groups. The cysts disappeared in 13 patients [81%] in the drainage group and in 11 [73%] in the surgery group [P 0.29] and were replaced by solid echo pattern in 3 patients [19%] in the drainage group and in 4 patients [27%] in the surgery group.. After an initial rise in 3 patients of the drainage group and 2 patients of the surgery group, the echinococcal-antibody titers fell progressively and at the last follow-tip were <1:160 in 15 patients [94%] of the drainage group and 13 patients [87%] of the surgery group. There were procedure-related minor complications in 5 patients [3 1%] in the drainage group and 3 patients [20%] in the surgery group. No recurrences occurred in both groups during follow-up. Percutaneous drainage, combined with albendazole therapy, is an effective and safe alternative to surgery for the treatment of most types of hydatid cysts of the liver and requires a shorter hospital stay