Aim: To present our experience with management of complex hepatic hydatid cysts (Gharbi
type III), using percutaneous large bore catheter drainage followed by active mechanical
suction of cyst contents.
Methods: Eleven patients (6 males and 5 females with a mean age of 43.2 years), with 13
complex Gharbi type III hepatic hydatid cysts were included in the study. Under sonography
guidance the complex heterogeneous hepatic hydatid cysts were treated percutaneously
using large bore drainage catheter and active mechanical suction.
Results: Successful drainage of all 13 complex Gharbi type III hepatic hydatid cysts was
achieved in all patients (n = 11). The mean duration of catheter placement was 11.3 days
(range 7 to 40 days). The most common problem encountered was biliary fistula (n = 3), which
was effectively managed with prolonged catheter drainage and/ or endoscopic intervention.
No serious complications or deaths were encountered. Minor omplications were seen in 7
patients including, urticaria in 3, fever in 2 and reactive pleural effusion in 3. All patients
responded to symptomatic treatment. Follow up serial ultrasound was performed on all patients,
that showed near complete healing in 9 and formation of pseudotumour in 4 patients. There
was no recurrence with a mean follow up of 15.23 months (6 months – 2 years).
Conclusion: Percutaneous suction and large bore catheter drainage of Gharbi type III hepatic
hydatid cysts is a safe and effective alternative therapy.