Pp. 203–209 Hepatic hydatid cyst – diagnose and treatment algorithm

Materials and Methods
Between January 2014 and June 2017, 88 patients 
diagnosed with hepatic hydatid cyst were admitted and 
treated at the General Surgery Clinic of the “Colentina” 
Hospital in Bucharest. The following parameters were taken 
into consideration: age, gender, place of origin, year and 
duration of admission, symptoms and signs at admission, 
serological and paraclinical investigations relevant to liver 
function and E. granulosus infection, the performed imaging 
investigations and their results, the received treatment and 
post-treatment evolution and complications.
Of the total number of patients enrolled in the study, 
50 were female and 38 male. The age groups with the 
most representatives were 30-39 years and 40-49 years. 
The number of female patients was higher in the 30-39 
and 40-49 age groups. Over half of the female patients 
liver without communicating with the biliary tree [11]. 
They can also be attempted in the case of multiple cysts 
(but fewer than three). The types of interventions that 
may be performed by laparoscopy are pericystotomy 
with cystectomy, partial or total pericystectomy, hepatic 
segmentectomy. It should be specified that laparoscopic liver 
resections are practiced with restrain, although mortality 
is around 1% [13]. During laparoscopic interventions, 
there is a higher risk of intraperitoneal hydatid fluid loss 
with the occurrence of secondary hydatidosis [9]. Haito 
et al. recommend that conservative operations should be 
performed laparoscopically, such as endocystectomy or 
total cystectomy, that allow the dissection at the level of 
the pericyst. He concludes that laparoscopic intervention 
is easier in small cysts (less than 6 cm) with superficial 
localization and in a more advanced stage of development 
[14]. The contraindications of laparoscopy are cyst rupture 
in the biliary tree, central cyst localization, cystic dimensions 
over 15 cm, thickened or calcified cystic walls [9].
The interventional endoscopy includes stenting 
on the main bile duct, Endoscopic Retrograd 
Cholangiopancreatography (ERCP), endoscopic 
sphincterotomy.
The minimally invasive techniques used in hepatic 
hydatid cyst treatment are PAIR, PAIRD, Modified 
Catheterisation Technique (MoCaT) or Percutaneous 
Evacuation (PEVAC). The PAIR technique (puncture, 
aspiration, injection of 95% ethanol solution or hypertonic 
saline solution, re-aspiration) is applicable to the hepatic 
hydatid cyst in stages CE1, CE2, CE3. The indications 
are: cyst with daughter vesicles +/-, detached proligere 
membrane, multiple cysts if accessible to puncture, 
superinfected cyst, patients refusing surgery, post-surgical 
relapse, patients with a surgical contraindication, patients not 
responding to drug therapy, pregnancy. Contraindications: 
non-cooperative patients, cysts that can not be punctured,