**9. Conclusion**

*Liver Disease and Surgery*

**7. Percutaneous treatment**

1. Non-echoic lesion 5 cm in diameter

3. Multiple cysts if accessible to puncture

4. Infected cysts

7. Patient who refuse surgery 8. Patients who relapse after surgery

9. Children >3 years old 10. Pregnant women

1. Noncooperative patient

4. Inactive or calcified lesion

2. Inaccessible or risky location of the liver cyst 3. Cyst in the spine, brain, and/or heart

5. Cyst communicating with the biliary tree

**Table 3.**

**Table 4.**

*Indications for PAIR.*

2. Cysts with daughter cysts and/or membrane detachment

5. Patients who fail to respond to chemotherapy alone 6. Patients in whom surgery is contraindicated

study of the risk factors that determine the postoperative morbidity in a significant number of international publications. The results indicate a fairly low level of evidence [55]. The challenge is to perform a prospective series, to achieve consensus

This therapy is carried out by means of puncture, aspiration, injection of scolicidal agents, and reaspiration of fluid and hydatid membranes (PAIR). The procedure is performed under ultrasonographic guidance in selected cases. This procedure was developed by a Tunisian team in 1986. The WHO recommends this procedure because it is less invasive when compared to surgery, allows a good evacuation of the parasite, reduces the time of hospitalization, and is less expensive. The following guidelines contain indications and contraindications for this procedure (**Tables 3** and **4**) [56]. It is necessary to have anesthesiological support to treat an eventual anaphylaxis crisis due to hydatid fluid spillage while PAIR is performed [57].

The use of treatments with drugs capable of penetrating and collapsing hepatic hydatid cysts is reported in numerous publications. These drugs are prescribed alone or together with surgery and less-invasive therapies such as PAIR. Currently, albendazole has shown effectiveness in reducing the size or even causing the death of the parasite. For this reason, it is employed to prevent recurrence after surgery. It is also used as the only therapy in patients who refuse surgery or who are inoperable due to disseminated

on the indications of surgery to treat this complex disease.

**166**

**8. Chemotherapy**

*Contraindications for PAIR.*

Hepatic hydatidosis is still a disease that spreads without epidemiological control in many parts of the world. Also, a continuous biological adaptation of the parasite to subsist in the intermediate host has been demonstrated, which would explain the great difficulties in eradicating this zoonosis. The permanent and even increasing incidence of this disease determines very high health costs necessary to treat patients, sometimes with complex pathological presentations. Efforts are being made to find new alternatives to diagnose early stages of the parasitosis. The creation of new vaccines with the intention of immunizing the intermediate host would determine a better control of human hydatidosis. Surgical advances are allowing for more and more radical surgical procedures with acceptable rates of morbidity and mortality. However, the implementation of minimally invasive surgeries presents significantly higher costs. Logic would dictate that the best path is to minimize the number of new patients affected through successful epidemiological control.
