World J. Surg.
28, 731–736, 2004
DOI: 10.1007/s00268-004-7516-z
Editorial Update
Treatment of Hydatid Cyst of the Liver: Where Is the Evidence?
Chadli Dziri, M.D., F.A.C.S.,1 Karim Haouet, M.D.,2 Abe Fingerhut, M.D., F.A.C.S., F.R.C.S. (G)3
1
Division of General Surgery, Department of Emergency, Hôpital Charles Nicolle, Bd 9 Avril 1938, 1006 Tunis, Tunisia
2
Division of General Surgery, Surgical Unit A Hôpital Charles Nicolle, Bd 9 Avril 1938, 1006 Tunis, Tunisia
3
Department of Surgery, Centre Hospitalier Intercommunal, 78303 Poissy Cedex, France
Published Online: August 3, 2004
Abstract. Treatment of hydatid cyst of the liver ranges from surgical inter-
vention (conventional or laparoscopic approach) to percutaneous drainage
and to medical therapy. The aim of this systematic review was to provide
“evidence-based” answers to the following questions: Should chemo-
therapy be used alone or in association with surgery? What is the best sur-
gical technique? When is the percutaneous aspiration injection and reaspi-
ration technique (PAIR) indicated? An extensive electronic search of the
relevant literature without limiting it to the English language was carried
out using MEDLINE and the Cochrane Library. Key words used for the
final search were “hydatid cyst,” “liver,” “treatment,” “meta analysis,”
“randomized controlled trial,” “prospective study,” “retrospective study.”
All relevant studies reporting the assessment of one modality of treatment
or a comparison of two or several therapeutic methods to treat hydatid cyst
of the liver and published in a peer-reviewed journal were considered for
analysis. This systematic review allowed us to conclude that chemotherapy
is not the ideal treatment for uncomplicated hydatid cysts of the liver when
used alone (level II evidence, grade B recommendation). The level of evi-
dence was too low to help decide between radical or conservative treatment
(level IV evidence, grade C recommendation). Omentoplasty associated
with radical or conservative treatment is efficient in preventing deep ab-
scesses (level II evidence, grade A recommendation). The laparoscopic ap-
proach is safe (level IV evidence, grade C recommendation). Drug treat-
ment associated with surgery (level II evidence, grade C recommendation)
requires further studies. Percutaneous drainage associated with albenda-
zole therapy is safe and efficient in selected patients (level II evidence,
grade B recommendation). The level of evidence is low concerning treat-
ment of complicated cysts.
Hydatid cyst is a parasitic disease caused by the tapeworm Echino-
coccus granulosus. The tapeworm stage is harbored in the carni-
vore’s intestine (e.g., dog), which is called the “definitive host.” The
tapeworm eggs are passed in the feces of an infected carnivore and
are ingested by an herbivore (e.g., sheep), called the “intermediate
host.” The eggs hatch in the intestine of the herbivore, penetrate
the intestinal wall, and reach the liver via the portal vein, where
they develop into a hydatid cyst. Echinococcus infestation occurs in
humans when they accidentally ingest tapeworm eggs. The hydatid
cyst is frequently encountered in endemic areas: Mediterranean
countries [1–3], New Zealand, Australia, North America, South
Correspondence to: Chadli Dziri, M.D., F.A.C.S., e-mail: chadli.
dziri@planet.tn
WORLD
Journal of
SURGERY
© 2004 by the Société
Internationale de Chirurgie
America, Central America, and Asia [4]. The most complete
known study on the prevalence of the clinical pattern was reported
in 1994 [5]. This retrospective multicenter study collected 2013 pa-
tients who had been operated on for hydatid cyst of the liver. The
most frequent clinical patterns were uncomplicated cysts (82%),
cysts that had ruptured into the biliary tract with a large biliocystic
fistula of more than 5 mm (12%), and cysts involving the thorax
(2.2%); the remaining patients had other, rare complications.
The diagnosis of an uncomplicated cyst depends on clinical sus-
picion; pain in the right upper quadrant is the most common symp-
tom, and hepatomegaly or a palpable mass is the most common
finding. Acute cholangitis is the most common syndrome when the
ruptured hydatid cysts are in the biliary tract [6]. Lower chest pain,
a productive cough, and hemoptysis are the most frequent symp-
toms when there is thoracic involvement [7]: bilioptysis is diagnos-
tic of a biliobroncheal fistula. Ultrasonography is a useful tool for
confirming the diagnosis of hydatid cyst of the liver and its compli-
cations [6–8].
According to the five categories noted in the classification of
Gharbi et al. [9], types II and III are characteristic of hydatid cysts,
types I and V are suggestive of hydatid cysts in endemic areas, and
type IV simulates a pseudotumor. Computed tomography (CT) is a
helpful tool for confirming the diagnosis, essentially when an ultra-
sound examination shows a type IV sonographic pattern. Serologic
tests cannot supplant clinical or imaging investigations, but they
can confirm the hydatid origin of a cyst [10].
Treatment of hydatid cysts of the liver varies, from surgical intervention
(conventional or laparoscopic approach) to percutaneous drainage to
medical therapy. This article is a systematic review aimed at providing
“evidence-based” answers to the following questions: Should chemo-
therapy be used alone or in association with surgery? What is the best
surgical technique? When is the percutaneous aspiration injection and
reaspiration technique (PAIR) indicated?
Methods
Search Strategy
An extensive electronic search of the relevant literature without
limiting it to the English language was carried out using Medline
732
and the Cochrane Library. The date of the last electronic search
was December 15, 2003. Key words used for the final search were
“hydatid cyst,” “liver,” “treatment,” “meta-analysis,” “randomized
controlled trial,” “prospective study,” retrospective study.”
Inclusion and Exclusion Criteria, Endpoints
All relevant studies that reported the assessment of one modality of
treatment or a comparison of two or several therapeutic methods to
treat hydatid cyst of the liver, and published in a peer-reviewed
journal, were considered for analysis. Data from editorials, letters
to editors, review articles, and animal studies were excluded from
the analysis. Structured abstracts of all potentially relevant articles
were screened and accepted for analysis. For this analysis we took
into account mortality and morbidity rates (including as deep ab-
dominal complications such factors as bile leakage, bleeding, deep
abscesses, the viability of the cyst evaluated by its echo pattern or an
ultrastructure study, and the recurrence rate).
Validity Assessment
Each publication was reviewed independently by two of the authors
(C.D., K.H.) and then cross-checked. Differences in opinion were
settled by discussion. The authors evaluated all randomized trials
to determine if they were in accordance with the revised Consoli-
dated Standards of Reporting Trials (CONSORT) statement of
2001 [11]. The revised CONSORT statement includes 22 items that
pertain to the content of the title, abstract, introduction, methods,
results, and discussion. The CONSORT statement enabled the au-
thors to understand the trial’s conduct and to assess the validity of
its results. To assess the quality of nonrandomized controlled trials
we used the Methodological Index for Non-Randomized Studies
(MINORS) [12], an instrument that assesses the methodologic
quality of nonrandomized surgical studies, whether comparative or
noncomparative. The MINORS index contains 12 items, which are
scored 0 (not reported), 1 (reported but inadequate), or
2 (reported and adequate). The ideal global score is 24 for compara-
tive studies and 16 for noncomparative studies. Nonrandomized
studies with a MINORS index higher than 12 for comparative stud-
ies and 8 for noncomparative studies were retained for analysis.
Data Collection and Analysis
All randomized controlled trials (RCTs) were included in our
study. For these RCTs and as an estimate of the clinical relevance
of any difference between treatments, we calculated the number-
needed-to-treat (i.e., the number of patients the clinicians must
treat for a particular period of time to prevent one adverse target
event), with its 95% confidence interval.
A qualitative analysis was adopted, and conclusions were based
on levels of evidence and grades of recommendation according to
Cook et al. [13] and Sackett [14] (Table 1). For more accuracy, we
presented the results for uncomplicated and complicated hydatid
cysts of the liver separately [5, 15].
Results
Retrieved Reports
We screened 146 reports. After verifying the inclusion and exclu-
sion criteria and the validity assessment, we retained 46 studies for
World J. Surg. Vol. 28, No. 8, August 2004
Table 1. Definitions of evidence levels and grades of recommendation.
Level I: evidence obtained from meta-analysis of multiple well designed
controlled studies; randomized trials with low false-positive and
false-negative errors (high power)
Level II: evidence obtained from at least one well designed experimental
study; randomized trials with high false-positive and false-negative
errors or both (low power)
Level III: evidence obtained from well designed, quasi-experimental
studies, such as nonrandomized, controlled, single-group,
preoperative/postoperative comparison, cohort, time, or matched
case-control series
Level IV: evidence obtained from well designed nonexperimental
studies, such as comparative and correlational descriptive and case
studies
Level V: evidence obtained from case reports and clinical examples
Grade A: evidence of type I or consistent findings from multiple studies
of types II, III, or IV
Grade B: evidence of types II, III, or IV; findings are generally
consistent
Grade C: evidence of types II, III, or IV; findings are inconsistent
Grade D: little or no systematic empiric evidence
final analysis: one meta-analysis, six RCTs [16–21] (Table 2), 5 pro-
spective nonrandomized comparative trials, 6 prospective noncom-
parative studies, and 28 retrospective studies (3 comparative, 25
noncomparative). Three RCTs were in accordance with 16 to 20
items of the CONSORT statement, two were in accordance with 12
and 13 items, respectively, and the sixth randomized trial was in
accordance with only 9 items.
Uncomplicated Hydatid Cysts
Medical Treatment Alone. Concerning medical treatment using
benzimidazole compounds [albendazole (ABZ), mebendazole
(MBZ)], the first four patients treated successfully with mebenda-
zole were reported in 1977 [22]. In one retrospective study [23],
seven patients who had not undergone surgery received mebenda-
zole (50 mg/kg body weight) alone in repeated cycles of 1 month’s
duration separated by a treatment-free interval of 2 months. After
a median of 55 months, six of the seven patients were considered
therapeutic successes demonstrated by ultrasonography and CT.
Three available RCTs showed that ABZ had a better effect on hy-
datid cysts than placebo [17, 21] or MBZ [20]. One prospective con-
trolled trial compared ABZ and praziquantel versus ABZ alone
[24] and concluded that the combined treatment was more effective
than ABZ alone. However, complete disappearance of all cysts was
not reached according to these data. Therefore chemotherapy is
not the ideal treatment for hydatid cyst of the liver when used alone
(level II evidence, grade B recommendation).
Radical or Conservative Surgical Treatment? Surgery remains the
cornerstone of the treatment for hydatid cyst of the liver. Surgical
treatment can be divided into radical and conservative approaches.
The radical procedures include pericystectomy and hepatic resec-
tion. Conservative surgical treatment includes unroofing associ-
ated with various associated procedures for management of the re-
sidual cavity.
A retrospective, comparative study [25] involving 269 patients
showed that in the group treated by conservative surgery the overall
mortality was 32.5%, whereas in the group treated by radical sur-
gery it was 27% (p < 0.05). Three retrospective, noncomparative
Dziri et al.: Treatment of Liver Hydatid Disease
Table 2. Randomized controlled trials retained for analysis.
RCT Year Treatments
Khuroo [16] 1993 ABZ vs. PD vs. ABZ+PD
Gil-Grande [17] 1993 ABZ vs. placebo
Khuroo [18] 1997 ABZ+PD vs. surgery
Dziri [19] 1999 OP vs. no OP
Franchi [20] 1999 ABZ vs. MBZ
Keshmiri [21] 2001 ABZ vs. placebo
RCT: randomized controlled trial; ABZ: albendazole; MBZ: mebendazole; PD: percutaneous drainage; OP: omentoplasty; NNT: number-needed-
to-treat; CI: confidence interval; CONSORT: consolidated standards of reporting trials.
studies [26–28] also concluded that radical procedures are safe and
efficient. Finally, Belli et al. [29] reported a retrospective study that
concluded that pericystectomy in the presence of normothermic
ischemia improved the results of surgery for hepatic hydatidosis.
No randomized trial comparing radical versus conservative
treatment is currently available. The only prospective comparative
study was reported by Tasev et al. [30], who compared 102 patients
undergoing radical surgery with 250 patients undergoing conserva-
tive surgical procedures. Tasev et al [30] concluded that radical sur-
gical procedures were associated with lower postoperative morbid-
ity and mortality rates and a shorter postoperative hospital stay.
However, these procedures were performed more frequently for
hydatid cysts located in the left hepatic lobe [30]. Schmidt-
Matthiesen et al. [31] reported a comparative retrospective study
and concluded that conservative procedures are preferable to peri-
cystectomy which had the higher morbidity. Moumen et al. [32] re-
ported retrospectively on 360 patients who were treated conserva-
tively by unroofing (resection of the prominent dome) of the
hydatid cyst of the liver. They found that mortality was low (1.3%),
a clear advantage of this method with regard to radical surgery.
The radical procedures include pericystectomy and hepatic re-
section, which increase the operative risk for a benign disease.
However, these procedures are associated with a lower risk of re-
currence. The conservative procedures are safer and easier to per-
form, although the morbidity is more prevalent. It is not possible to
conclude which treatment is better because the level of evidence
was low (level IV evidence, grade C recommendation).
We definitely need more prospective, especially randomized, tri-
als to provide a high level of evidence.
As concerns postoperative complications, the presence of a re-
sidual cavity or biliocystic fistula after unroofing or difficulty con-
trolling bleeding and bile leaks of the hepatic parenchyma after
pericystectomy can lead to associated blood or bile collections, po-
tential sources of deep suppuration; the reported rates are 12%
[33] to 26% [2]. A variety of techniques, including omentoplasty,
introflexion, capitonnage, external drainage, and human fibrin glue
on the surface have been recommended to prevent this postopera-
tive complication.
Balik et al. [34] reported a retrospective study of 304 patients and
concluded that omentoplasty and capitonnage were superior to
tube drainage. Demirci et al. [35] reported a retrospective study of
260 patients with hydatid cysts of the liver treated surgically. They
concluded that for management of uncomplicated hydatid cysts of
the liver surgical techniques that do not employ drainage of the
cystic cavity were superior to those that used drainage.
One randomized controlled trial [19] comparing omentoplasty in
733
CONSORT
statement NNT
Endpoint (22 items) (95% CI)
echo pattern 13 9 (3–13)
viability 12 2 (1–7)
echo pattern 18 6 (3–18)
deep abscess 20 10 (5–53)
echo pattern 9 4 (3–6)
echo pattern 16 2 (2–4)
the residual cavity to no omentoplasty showed deep abscess rates of
0% and 11%, respectively (p < 0.03). A nonrandomized controlled
trial reported by Mentes et al. [36] that compared omentoplasty
versus introflexion for hydatid cysts of the liver showed that pa-
tients with omentoplasty developed fewer complications and had a
significantly shorter hospitalization than those with introflexion.
On the other hand, Vagianos et al. [37] reported a prospective open
study of 67 consecutive patients with hepatic hydatidosis operated
on between 1985 and 1990 by conservative procedures and con-
cluded that there was no difference according to whether an omen-
toplasty was added. The use of human fibrin glue for treating the
residual parenchymal surface after total pericystectomy for hepatic
Echinococcus infection was evaluated by a nonrandomized con-
trolled trial [38]. The results of this study did not allow any definite
assessment of the role of fibrin. In summary, among all these pro-
cedures, omentoplasty is efficient for preventing deep abscesses
(level II evidence, grade A recommendation).
Laparoscopic Surgery
The theoretic advantages of the laparoscopic approach compared
with open surgery are a shorter hospital stay, lower incidence of
wound infection, and less postoperative pain. The disadvantages
are accessibility to the various locations, increased risk of spillage
of the cyst content, and the difficulty of aspirating the cyst content
when viscous. None of the studies that analyzed the laparoscopic
approach, whether retrospective or prospective, were comparative
or randomized.
Emel’ianov and Khamidov [39] used the laparoscopic approach
for 37 patients and had one conversion. Khoury et al. [40] reported
108 patients with hydatid cyst of the liver operated on by the lapa-
roscopic approach. The mean operating time was 80 minutes
(range 40–180 minutes). There was no mortality; 11% of the pa-
tients had complications, and disease recurrence was recorded in
3.6% with a mean follow-up of 30 months (range 4–54 months).
Khoury et al. [40] concluded that the laparoscopic approach to un-
complicated hydatid cysts of the liver was a safe, effective option
with favorable long-term results. Manterola et al. [41] reported
eight patients with liver hydatid cysts treated by laparoscopic peri-
cystectomy, with no morbidity. The hospital stay was 2 days for all
patients who returned to work within 15 days. No hydatid recur-
rence was observed with a mean follow-up of 30 months (range
23–44 months). Bickel et al. [42] evaluated the laparoscopic ap-
proach by a prospective, nonselective study using the isolated
hypobaric technique. Altogether, 31 patients, with no selection
criteria, underwent 32 consecutive laparoscopic operations.
734
Perioperative complications occurred in five patients (16%), with
no evidence of recurrence during the mean follow-up of 49 months
(range 9–97 months).
Kayaalp [43] reported 19 patients with 30 hydatid cysts of the
liver who underwent evacuation of the cysts directly through a lap-
aroscopic trocar inserted through a traditional subcostal incision.
These authors concluded that the success rate of evacuating ante-
rior cysts was higher (73%) than for posterosuperior cysts (13%)
(p = 0.005), and there were no recurrences with a mean follow-up
of 11 months (range 3–24 months). Kathkouda et al. [44] and
Descottes et al. [45] also concluded in favor of the safety of the
laparoscopic approach in selected patients with benign solid and
cystic lesions of the liver including hydatid cysts.
The laparoscopic approach is thus safe (level IV evidence, grade
C recommendation). Further studies, however, are needed to
evaluate the recurrence rate.
Drug Treatment with Surgery
In 1993 Gil-Grande et al. [17] showed in a RCT that protoscolex
and cyst viability were significantly lower (p = 0.039 and p = 0.018,
respectively) in patients treated by ABZ (10 mg/kg/day) than in
controls. In 1996 Aktan and Yalin [46] reported a prospective com-
parative nonrandomized study that included 70 patients. They
showed that ABZ was more effective in decreasing the viability of
liver hydatid cysts when given for 3 weeks before operation. In 1997
a prospective open study [47] included 25 patients who had taken
ABZ (10 mg/kg/day for 1 month) before and during 2 months after
intervention. The authors observed one recurrence with a mean
follow-up of 29 months. These data can be classed as level II evi-
dence and grade C recommendation.
Drug Treatment with Percutaneous Drainage
Two retrospective studies [48, 49] reported 51 and 52 patients, re-
spectively, who underwent percutaneous drainage with two epi-
sodes of reversible anaphylaxis. Two prospective noncomparative
studies [50, 51] concluded that percutaneous drainage was safe, ef-
ficient, and offered complete cure in selected patients: patients
with sonographic types I, II, and III according to the Gharbi et al.
classification [9] and patients who have contraindications to sur-
gery, with a short hospitalization.
One RCT [16] that compared percutaneous drainage alone ver-
sus ABZ alone versus ABZ associated with percutaneous drainage
showed that percutaneous drainage with ABZ was an effective
form of management for hepatic hydatid cysts. Another RCT [18],
which compared ABZ with percutaneous drainage versus surgery,
demonstrated that percutaneous drainage combined with ABZ was
an effective, safe alternative to surgery for the treatment of uncom-
plicated hydatid cysts of the liver and required a shorter hospital
stay. Furthermore, Smego et al. [52], using a meta-analysis, com-
pared the clinical outcomes of 769 patients with hydatid cyst of the
liver treated with PAIR plus ABZ or MBZ versus 952 era-matched
historical control subjects undergoing surgical intervention. They
concluded that, compared with surgery, PAIR plus chemotherapy
is associated with more clinical and parasitologic efficacy; lower
rates of morbidity, mortality, and disease recurrence; and shorter
hospital stay [52].
These data suggest that percutaneous drainage associated with
World J. Surg. Vol. 28, No. 8, August 2004
albendazole therapy is safe and efficient (level II evidence, grade B
recommendation).
Complicated Hydatid Cysts
Hydatid Cysts Ruptured into the Biliary Tract. Only retrospective
studies [6, 53–55] are available in the literature regarding hydatid
cysts that have ruptured into the biliary tract. The principal diffi-
culty resides in the management of the large biliocystic fistula: su-
ture, internal transfistulary drainage, or direct fistulization. In the
multicenter study reported by Zaouche [5], the overall mortality
and morbidity rates were 4.5% and 38.5%, respectively: suture
(5.3% and 49.4%, respectively); internal transfistulary drainage
(1.9% and 11.5%, respectively); direct fistulization (3.7% and
62.9%, respectively).
Hydatid Cysts Involving the Thorax. Only retrospective studies are
available in the literature [7, 56–61] on the subject of hydatid cysts
involving the thorax. Thoracic surgeons are in favor of the thoracic
approach when the common bile duct is free, whereas digestive sur-
geons systematically favor the abdominal approach. The level of
evidence is low.
Conclusions
This systematic review allowed us to arrive at the following conclu-
sions about the treatment of uncomplicated hydatid cysts.
1. Chemotherapy is not the ideal treatment of hydatid cyst of the
liver when used alone (level II evidence, grade B recommenda-
tion).
2. The level of evidence is too low to help decide between radical
or conservative treatment (level IV, grade C recommendation).
3. Omentoplasty associated with radical or conservative treatment
is efficient for preventing deep abscesses (level II evidence,
grade A recommendation).
4. The laparoscopic approach is safe (level IV evidence, grade C
recommendation). However, further studies are necessary to
evaluate the recurrence rate.
5. Drug treatment associated with surgery requires further studies
(level II evidence, grade C recommendation).
6. Percutaneous drainage associated with albendazole therapy is
safe and efficient in selected patients (level II evidence, grade B
recommendation).
The level of evidence is low concerning treatment of complicated
hydatid cysts of the liver.
To the best of our knowledge, this is the first review in the litera-
ture that has focused on the problem of evidence-based surgery
concerning the treatment of hydatid cyst of the liver. There are
many questions but few answers. We need further studies, essen-
tially RCTs, which are the best available method for evaluating al-
ternative therapies including surgical procedures.
Although the level of evidence was low for the question of wheth-
er radical or conservative treatment is preferable, the tendency is
that radical treatment (pericystectomy or hepatic resection) is pre-
ferred to conservative procedures because it eliminates the peri-
cyst, which is a potential source of recurrence. However, radical
treatment is not always possible, and for some locations (e.g., the
dome of the liver) this technique is associated with risks and the
Dziri et al.: Treatment of Liver Hydatid Disease
need for more transfusions [15]. The enthusiasm for the laparo-
scopic approach should not continue unleashed, and multicenter
randomized trials comparing the traditional approach (e.g., sub-
costal incision) to the laparoscopic approach should be performed.
Percutaneous drainage combined with ABZ is an effective, safe al-
ternative to surgery for the treatment of uncomplicated hydatid
cysts of the liver, but we need more RCTs.
Several questions remain without answers: What is the best scoli-
cidal fluid? What are the best procedures for complicated cysts?
Further studies with sound methodology and a high level of evi-
dence are needed.
Résumé. Le traitement du kyste hydatique du foie comprend plusieurs
options allant de la chirurgie (par laparotomie ou par coelioscopie) au
drainage percutané et au traitement médical. Le but de cette revue
systématique a été de répondre aux questions suivantes en se basant sur
une médecine avec niveau de preuve: Peut-on utiliser le traitement médical
seul ou doit-il être associé à la chirurgie? Quelle est la meilleure technique
chirurgicale? Quelles sont les indications actuelles de la Ponction-
Aspiration-Injection et Réaspiration? Une large recherche électronique
d’articles pertinents sans limitation à la langue anglaise a été faite dans les
bases Medline et Cochrane. Les mots clefs utilisés étaient “kyste hydatique,”
“foie,” “traitement,” “méta analyse,” “essai randomisé,” “étude prospective,”
“étude rétrospective.” Toutes les études pertinentes rapportant l’évaluation
d’une méthode ou la comparaison de deux ou plusieurs méthodes de
traitement du kyste hydatique du foie et publiés dans des revues indexées
ont été retenues. Cette revue systématique nous a permis de conclure que
pour le traitement des kystes hydatiques non compliqués le traitement
médical utilisé seul ne constitue pas le traitement idéal (Niveau de preuve
II, Grade de Recommandation B). Le niveau de preuve est très bas pour
choisir entre chirurgie radicale ou conservatrice (Niveau de preuve IV,
Grade de recommandation C). L’omentoplastie associée à une chirurgie
radicale ou conservatrice est efficace dans la prévention de la survenue
d’abcès profonds avec un Niveau de preuve II et un Grade de recommandation
A. L’abord laparoscopique est faisable avec sécurité (Niveau de preuve IV –
Grade de recommandation C). L’indication du traitement médical associé
à la chirurgie: Niveau de preuve II avec un Grade de recommandation C,
nécessite d’autres études. Le drainage percutané associé à l’albendazole est
efficace pour des patients sélectionnés (Niveau de preuve II et un Grade de
recommandation B). Quant au traitement des kystes hydatiques du foie
compliqués, le niveau de preuve est bas.
Resumen. El tratamiento del quiste hidatı́dico de hı́gado varı́a desde la
intervención quirúrgica (convencional o por vı́a laparoscópica) hasta el
drenaje percutáneo y el tratamiento médico. El objetivo de esta revisión
sistemática basada en la medicina factual, intenta responder a las siguientes
preguntas: ¿Debe utilizarse la quimioterapia sola o asociada a la cirugı́a?
¿Cuál es la mejor técnica quirúrgica? ¿En qué casos está indicada la
técnica de aspiración inyección percutánea y reaspiración (PAIR)? Se
realizó una amplia búsqueda electrónica de la literatura más importante al
respecto sin limitarnos solo a la publicada en inglés, utilizando el Medline
y las bases de datos de la Cochrane Library. Las palabras clave utilizadas
fueron “quiste hidatı́dico,” “hı́gado,” “tratamiento,” “meta-análisis,”
“estudio randomizado controlado,” “estudio prospectivo,” “estudio
retrospectivo.” Todos los estudios importantes sobre una modalidad de
tratamiento o comparando dos o más métodos terapéuticos en el tratamiento
de la hidatidosis hepática, publicados en revistas con comité editorial de
expertos, fueron analizados. Esta revisión sistemática nos permitió
alcanzar las siguientes conclusiones: En el quiste hidatı́dico simple (no
complicado) la quimioterapia aislada no constituye el tratamiento ideal
(Nivel 2 de evidencia, Grado B de recomendación). El nivel de evidencia fue
muy bajo para permitir una decisión entre el tratamiento radical o
conservador (Nivel IV de evidencia, Grado C). La omentoplastia asociada a
un tratamiento radical o conservador es eficaz en la prevención de absceso
profundos con un nivel II de evidencia y un Grado A de recomendación. El
abordaje laparoscópico es seguro (nivel IV – Grado C). La asociación del
tratamiento farmacológico con el quirúrgico muestra un nivel II de
evidencia y un Grado C, pero requiere mas estudios al respecto. El drenaje
percutáneo asociado a la administración de albendazole es seguro y eficaz
en pacientes seleccionados con un nivel II de evidencia y un Grado B. Por
735
otra parte el nivel de evidencia es bajo por lo que concierne al tratamiento
de los quistes complicados.
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