From the Guidelines
Surgical treatment for Echinococcosis (hydatid disease) should be approached with caution, and the preferred technique is percutaneous aspiration and ethanol sclerosis, or video-assisted thoracotomy, rather than surgical excision of the cyst, as recommended by the most recent guidelines 1. The surgical approach for echinococcosis involves careful consideration of the cyst size, location, and stage, as well as the patient's overall health status.
- For simple liver cysts (stage 1) larger than 5 cm in diameter, puncture, aspiration, injection, and re-aspiration (PAIR) together with drug therapy is recommended 1.
- For cysts smaller than 5 cm in size, albendazole alone is recommended 1.
- For larger, extrahepatic, or multiple cysts, surgery may be indicated 1.
- Prior to any surgical or percutaneous intervention, patients should receive albendazole (400 mg twice daily for adults) for at least 1-4 weeks to reduce cyst viability 1. The use of scolicidal agents such as hypertonic saline (20%) or povidone-iodine to kill any released parasites during the operation is also crucial. Postoperatively, albendazole should be continued for at least 1-3 months to prevent recurrence 1. It is essential to note that surgery carries risks, including cyst rupture, infection, and damage to surrounding structures, so it should be performed by experienced surgeons. For inoperable cases or multiple small cysts, long-term medical therapy with albendazole may be the primary treatment approach 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Surgical Treatment Options
- Surgery is a common treatment option for Echinococcosis (hydatid disease) and can cure the patient if the parasite is removed entirely 2
- Surgical procedures include partial liver resection, opening of the parasitic cyst and removal of the parasite, and laparotomy, with laparoscopic methods being successful in selected cases 2
- Liver resection and pericystectomy are procedures that resect the closed cysts with a fairly wide safety margin, with a meta-analysis showing the best results regarding lethality, morbidity, and recurrence rates for resective operations 2
- Cystectomy and omentoplasty are also considered standard surgical procedures, as they are safe, simple, and effective, and meet all criteria of surgical treatment for hydatid disease 2
Comparison with Other Treatment Options
- Percutaneous treatment (PAIR) has been shown to have greater clinical efficacy, lower rates of major and minor complications, mortality, and disease recurrence, and fewer days of hospitalization compared to surgical treatment 3
- PAIR is considered a safe and effective procedure of choice for patients with hepatic echinococcosis, and perhaps other anatomic sites of infection, and surgery should be reserved for patients with hydatid cysts refractory to PAIR 3
- Benzimidazole treatment, such as albendazole, can be used as a supplementary treatment prior to and post-surgery, and has been shown to be effective in treating non-surgical cases 4
- A combined approach of medication, percutaneous techniques, and surgery may be used to treat uncomplicated hepatic cystic echinococcosis, with the optimal choice of treatment depending on the specific cyst stage and patient characteristics 5, 6
Recent Studies
- A 2024 Cochrane review found that there is very low-certainty evidence to indicate that standard catheterization plus albendazole may lead to fewer cases of recurrence, more major complications, and similar complication rates compared to PAIR plus albendazole in adults and children with CE1 and CE3a cysts 6
- The review also found that laparoscopic surgery plus albendazole may result in fewer cases of recurrence or fewer major complications compared to open surgery plus albendazole in adults and children with CE1, CE2, CE3a, and CE3b cysts, with laparoscopic surgery plus albendazole leading to slightly fewer minor complications and a reduced duration of hospital stay 6