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]
Overview
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[1][2][3][4]
| 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
- Reduced hospitalization time
- Cost of the puncture and chemotherapy usually less than that of surgery or chemotherapy alone
References
- ↑ Rajesh R, Dalip DS, Anupam J, Jaisiram A (2013). "Effectiveness of puncture-aspiration-injection-reaspiration in the treatment of hepatic hydatid cysts". Iran J Radiol. 10 (2): 68–73. doi:10.5812/iranjradiol.7370. PMC 3767020. PMID 24046781.
- ↑ Gabal AM, Khawaja FI, Mohammad GA (2005). "Modified PAIR technique for percutaneous treatment of high-risk hydatid cysts". Cardiovasc Intervent Radiol. 28 (2): 200–8. doi:10.1007/s00270-004-0009-5. PMID 15883860.
- ↑ Nasseri Moghaddam S, Abrishami A, Malekzadeh R (2006). "Percutaneous needle aspiration, injection, and reaspiration with or without benzimidazole coverage for uncomplicated hepatic hydatid cysts". Cochrane Database Syst Rev (2): CD003623. doi:10.1002/14651858.CD003623.pub2. PMID 16625588.
- ↑ Etlik O, Arslan H, Bay A, Sakarya ME, Harman M, Temizoz O, Kayan M, Bakan V, Unal O (2004). "Abdominal hydatid disease: long-term results of percutaneous treatment". Acta Radiol. 45 (4): 383–9. PMID 15323389.