A novel modified PAIR technique using a trocar catheter for percutaneous treatment of liver hydatid cysts: a six-year experience.

Hydatid disease is a parasitic infection caused by the larval stage of the tapeworm Echinococcus. E. granulosus is the most common cause of hydatid disease in humans and is found throughout the world. It is endemic in large sheep raising areas like the Mediterranean region, the Middle East, Southeast and Central Russia, Northern China, South America, Australia, and New Zealand (1). Hydatid disease usually affects the liver (50%–70%) and less frequently lung, peritoneum, kidney, brain, mediastinum, heart, bone, soft tissues, spinal cord, spleen, pleura, adrenal glands, bladder, ovary, scrotum, and thyroid gland (2). Treatment approaches include medical, surgical, and minimally invasive procedures. Medical treatment with albendazole or mebendazole alone has a low rate of success and high rate of relapse, making this treatment option controversial (3). The surgical approach has been the gold standard therapy for the hydatid disease for a long time (4). However, in recent years, percutaneous treatment of the hydatid cyst emerged as a potential alternative to surgery, because of its efficiency, reliability, and low morbidity and mortality rates. The puncture, aspiration, injection, and reaspiration (PAIR) technique, which involves puncture of the cyst wall, aspiration of cyst contents, instillation, and reaspiration of the scolicidal agent, has gained international recognition. PAIR technique can be achieved by using a coaxial catheter system to aspirate the cyst content and infuse scolicidal agent at the same time (5). Another technique can be performed by catheterization (3, 6). In our study, we performed the PAIR procedure by directly entering into the hydatid cyst cavity through a single puncture using a trocar catheter instead of placing a catheter through stiff wire after puncturing with a Seldinger needle. The primary goal of the current study was to determine the success and reliability of this technique in patients with hydatid disease.