title: Minimally Invasive Treatment of Liver Hydatidosis.
abstract: OBJECTIVE
  Open surgery has been the mainstay treatment for liver hydatidosis in the past. Today, for treatment of simple and uncomplicated cysts, we have a variety of choices: antihelmintic therapy, the PAIR (puncture, aspiration, injection, and respiration) technique, and the laparoscopic approach. We reviewed our series of 267 cases of hepatic hydatidosis submitted to surgery over a period of 20 years, from 1995 through 2014, comparing the results of these minimally invasive treatments.
  
  
  METHODS
  In 92 patients (25.7% of cases) who presented with complicated liver hydatid cysts, we performed open surgery. In 16.4% of cases (59 patients), we used a laparoscopic approach, and in 208 patients (57.9% of cases), we used the PAIR technique. All patients were monitored after surgery for a mean of 61.7 months (range, 16-127). Postoperative follow-up consisted of clinical examination, laboratory investigation, abdominal ultrasound, and magnetic resonance imaging.
  
  
  RESULTS
  Almost all patients (198, 95.2%) treated with the PAIR technique and 55 patients (93.2%) treated with the laparoscopic approach were cured. Six patients (2.8%) from the echo-guided puncture group had to undergo a repeat of the procedure because the cavity did not disappear after 2 years. In 4 patients (2%), we performed open surgery for 2 biliary fistulas and 2 hepatic abscesses. Four patients from the laparoscopic group needed additional procedures. Open surgery was necessary in 2 patients for a recurrence after 2 years; 1 patient had developed a liver abscess and the other had a biliary fistula.
  
  
  CONCLUSIONS
  In conclusion, open surgery remains the viable option for complicated cysts, with biliary communication, with multiple daughter vesicles, or with calcified walls. For simple, uncomplicated hydatid cysts, both methods (the PAIR technique and laparoscopic procedure) are safe and efficient, with very good results and low morbidity rates.
authors.affiliation: Surgical Clinic 2, University of Medicine and Pharmacy, "V. Babes," Timisoara, Romania.
authors.forename: Ciprian
authors.initials: C
authors.lastname: Duta
authors.affiliation: Surgical Clinic 2, University of Medicine and Pharmacy, "V. Babes," Timisoara, Romania.
authors.forename: Stelian
authors.initials: S
authors.lastname: Pantea
authors.affiliation: Surgical Clinic 2, University of Medicine and Pharmacy, "V. Babes," Timisoara, Romania.
authors.forename: Caius
authors.initials: C
authors.lastname: Lazar
authors.affiliation: Surgical Clinic 2, University of Medicine and Pharmacy, "V. Babes," Timisoara, Romania.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Salim
authors.affiliation: Surgical Clinic 2, University of Medicine and Pharmacy, "V. Babes," Timisoara, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Barjica
mesh_terms: D000293:Adolescent; D000368:Aged; D004444:Echinococcosis, Hepatic / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Laparoscopic approach; Liver hydatidosis; Percutaneous echo-guided puncture