COMPARISON OF ALBENDAZOLE THERAPY WITH PAIR THERAPY FOR HYDATID CYST OF LIVER AT A TERTIARY CARE HOSPITAL
Hydatid disease is a common parasitic infestation of liver in many parts of the world where animal husbandry is integral to community life. Hepatic hydatid cyst may present incidentally without symptoms, or as right upper abdominal pain. Surgical treatment in the form of marsupialisation, omentoplasty or hepatectomy has been the mainstay of treatment. However, advent of albendazole and PAIR therapy has changed the treatment modality of large number of patients. Drug therapy PAIR (percutaneous aspiration injection and respiration) is now a well established modality of treatment of hepatic hydatid cysts. However, its role in comparison to PAIR therapy and surgical therapy is contended. Cumulative experience of clinical presentations and management of hepatic hydatid cyst at a tertiary care hospital with special reference to albendazole therapy and PAIR therapy is presented. Patients presenting to GE (gastroenterology) outpatient with hepatic hydatid disease were managed medically and by PAIR therapy. Cases were retrieved from departmental records. Medical therapy alone and PAIR therapy were compared. Sixty patients of hepatic hydatid disease were for drug therapy or PAIR therapy. Fifty patients had solitary cyst. Forty five patients presented with right upper quadrant pain as the only presentati on. Twenty one cysts were small or inaccessible and received albendazole therapy alone. Eighteen patients responded to medical therapy alone. Thirty seven patients received PAIR therapy. Twenty six patients improved. Eleven patients required multiple sessions of PAIR. Seven patients failed to respond despite repeated aspirations and were referred for surgery. Five were lost to follow up. Drug ther apy alone or combined with PAIR therapy is a useful for successful treatment of 90 % of uncomplicated hepatic hydatid cysts smaller than 10 cm in diameter. Success of PAIR therapy is limited by inaccessible or difficult location, multi -locularity and high intracystic particulate matter causing repeated needle blockage and high number of therapy side effects