Echinococcosis surgery: Difference between revisions
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|Every week for the 1st month, then every other month for the 1st year, then every year for 10 years | |Every week for the 1st month, then every other month for the 1st year, then every year for 10 years | ||
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===Contraindications for PAIR=== | |||
* Non-cooperative patients and inaccessible or risky location of the cyst in the liver | |||
* Cyst in spine, brain and/or heart | |||
* Inactive or calcified lesion | |||
* Cysts communicating with the biliary tree | |||
* Cysts open into the abdominal cavity, bronchi and urinary tract | |||
===Benefits of PAIR=== | |||
* Minimal invasiveness | |||
* Reduced risk compared with surgery | |||
* Confirmation of diagnosis | |||
* Removal of large numbers of protoscolices with the aspirated cyst fluid | |||
* Improved efficacy of chemotherapy given before and after puncture (probably because of an increased penetration | |||
of antihelminthic drugs into cysts re-filling with hydatid fluid ) | |||
* Reduced hospitalization time | |||
* Cost of the puncture and chemotherapy usually less than that of surgery or chemotherapy alone | |||
== References == | == References == | ||
Revision as of 18:40, 30 June 2017
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Echinococcosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Echinococcosis surgery On the Web |
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American Roentgen Ray Society Images of Echinococcosis surgery |
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Risk calculators and risk factors for Echinococcosis surgery |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Surgery
Indications for PAIR
Patients with:
- Non-echoic lesion ≥ 5 cm in diameter (CE1m and l)
- Cysts with daughter cysts (CE2), and/or with detachment of membranes (CE3)
- Multiple cysts if accessible to puncture
- Infected cysts
- Pregnant women
- Children >3 years old
- Patients who fail to respond to chemotherapy alone
- Patients in whom surgery is contraindicated
- Patient who refuse surgery
- Patients who relapse after surgery
PAIR Protocol
The critical points in the PAIR protocol can be summarized below
| PAIR Protocol | Preferred management |
|---|---|
| Prophylaxis pre- & post procedure | Albendazole
|
| Communication with biliary tree | ERCP + cystography or cystography alone |
| Electrolytes in the fluid | Not mandatory; may help for assessing the nature of the cyst |
| Scolicidal agent to be used | Hypertonic saline (at least 15 % final concentration in cyst) or 95 % alcohol |
| Quantity of scolicide injected | At least 1/3 of the aspirated quantity |
| Evaluation of viability | Microscopic examination Staining with methylene blue/eosin red |
| Needle vs catheter | Needle for cysts < 5 cm or in multiloculated cysts Catheter for cyst > 5 cm (PAIRD) |
| Follow-up | Every week for the 1st month, then every other month for the 1st year, then every year for 10 years |
Contraindications for PAIR
- Non-cooperative patients and inaccessible or risky location of the cyst in the liver
- Cyst in spine, brain and/or heart
- Inactive or calcified lesion
- Cysts communicating with the biliary tree
- Cysts open into the abdominal cavity, bronchi and urinary tract
Benefits of PAIR
- Minimal invasiveness
- Reduced risk compared with surgery
- Confirmation of diagnosis
- Removal of large numbers of protoscolices with the aspirated cyst fluid
- Improved efficacy of chemotherapy given before and after puncture (probably because of an increased penetration
of antihelminthic drugs into cysts re-filling with hydatid fluid )
- Reduced hospitalization time
- Cost of the puncture and chemotherapy usually less than that of surgery or chemotherapy alone