Over decades, surgery has been the only accepted mode of treatment for liver
hydatid cysts. It had been a surgical dogma for a long that
hydatid disease is an absolute
contraindication for needle
puncture/aspiration as it can cause
anaphylaxis, death, and dissemination. We envisaged prospectively perform percutaneous drainage as a primary form of treatment for
hepatic hydatidosis. Through extensive and very careful experimentation, we proved that aspiration of
hydatid cysts can be performed safely and is the ideal way to manage a subset of patients with
hydatid cysts in the liver. The patient and
cyst characteristics good and not good for percutaneous drainage were carefully selected. The procedure of percutaneous drainage of
hepatic hydatid cysts involves four sequential steps as defined in the alphabets of the title PAIR, denoting
puncture (P), Aspiration (A), Instillation (I), and Reaspiration (R). During and postprocedure, we enforced strict monitoring given the anticipated
anaphylaxis. The first PAIR procedure was performed in June 1988. The results of percutaneous drainage of 21
cysts in 12 patients were reported in 1991. Next, a prospective study was done to show that concomitant
Albendazole therapy is recommended as an adjuvant to percutaneous drainage for
hepatic hydatidosis. In a seminal prospective study comparing percutaneous drainage and surgery, we showed that percutaneous drainage is as good as surgery in the management of uncomplicated
hydatid cysts with fewer complications and shorter
hospital stays. Lastly, long-term follow-up results of percutaneous drainage on a large cohort of patients with
hepatic hydatid cysts were reported, with excellent results and no evidence of local, peritoneal or systemic dissemination. Based on these data percutaneous drainage, the so-called PAIR technique has established itself as a novel therapeutic advance in hepatic
hydatid disease.