Percutaneous Treatment of Hepatic Hydatid Cysts using Betadine and Hypertonic Saline

Introduction: Hydatid disease of the liver is an endemic disease in the rural areas of the cattle rearing countries of the world like India. Many treatment options are available for the same including surgery and medical therapy. The introduction of modified puncture aspiration, injection of scolicidal agent, and reaspiration (PAIR) under sonographic guidance in recent years has provided a new treatment option. Purpose: The purpose of this study was to evaluate the efficacy of percutaneous treatment of hepatic hydatid cysts under sonographic guidance using betadine (10% povidone iodine + 1% free iodine) and hypertonic saline (20%). Materials and Methods: A total of 48 patients are having Gharbi Type I and II cysts underwent modifi ed PAIR procedure under ultrasound guidance with the use of local anesthesia. 18G needle was used for the puncture of the cysts, and scolicidal agent was introduced. The scolicidal agents used were hypertonic saline in 24 patients and betadine in 24 patients which was allowed to act for a period of 30 min. The cysts were allowed to drain using a pigtail catheter which was left in situ. The patients were followed up for a period of 12 months. The therapeutic response was assessed by using serial ultrasound scans in all patients every 3 months for 1 year. Reduction in size, pseudomass formation, and wall calcifi cation were used as assessment parameters. Results: Reduction in size, pseudomass formation, and wall calcifi cation was seen in 46 patients. Two patients treated using hypertonic saline showed recurrence at 6 months who were then treated with betadine. Conclusion: Modifi ed PAIR therapy is a cost-effective, safe, well tolerated, and minimally invasive treatment for the treatment of Gharbi Type I and Type II hepatic hydatid cysts. The betadine is a preferred scolicidal agent compared to hypertonic saline.