A number of surgical and non-surgical options exist to treat
cystic echinococcosis of the liver. For decades, surgical excision via a conservative or radical approach was the recommended approach for
hepatic hydatid cysts. The availability of chemotherapeutic agents with significant activity against Echinococcus granulosis has made it possible to undertake ultrasound- or computed tomography-guided transhepatic percutaneous drainage (termed
puncture, aspiration, injection, and re-aspiration (PAIR)) of
hydatid cysts. Pre- and post-intervention
chemotherapy with
albendazole or
mebendazole offers the advantage of reducing the risk of disease recurrence and intraperitoneal seeding of
infection that may develop via
cyst rupture and spillage occurring spontaneously or during surgery or needle drainage. PAIR appears to have greater clinical efficacy (i.e. a higher incidence of cure), lower rates of major and minor complications, mortality, and disease recurrence, and fewer days of hospitalization compared to patients treated surgically. For patients who fail
drug therapy alone, PAIR is a safe and effective procedure of choice for patients with
hepatic echinococcosis, and perhaps other anatomic sites of
infection such as lung, peritoneum, kidney, and other viscera. Surgery should be reserved for patients with
hydatid cysts refractory to PAIR because of secondary
bacterial infection or for those with difficult-to-manage
cyst-biliary communication or obstruction.