World Review of Minimally Invasive Approaches for the Treatment of Hydatid Cysts: Laparoscopic, Thoracoscopic, and PAIR

Abstract

Background: Hydatid cysts, which are caused by the tapeworm Echinococcus Granulosus, present a serious health issue in endemic regions. Traditional open surgery, though effective, often results in substantial morbidity and extended recovery periods. Minimally invasive techniques have been increasingly utilized to mitigate these drawbacks, including laparoscopic, thoracoscopic, and PAIR (Puncture, Aspiration, Injection, and Reaspiration) procedures. This review aims to evaluate the safety, efficacy, and outcomes of these minimally invasive approaches.Methods: A literature search of PubMed and Google Scholar databases was conducted between January 1999 and May 2024. The search included studies related to minimally invasive procedures for treating hydatid cysts of the abdomen, pelvic, and thoracic cavities. Inclusion criteria comprised English-language articles, prospective and retrospective studies, comparative studies, case series, and case reports. Data on demographic details, procedure types, complications, and long-term outcomes were extracted and analyzed.Results: In total, 166 studies involving 3080 patients met the inclusion criteria for the review. Laparoscopic procedures were performed in 1538 cases, PAIR in 1312 cases, and thoracoscopic procedures in 573 cases. The liver was the organ most frequently affected, followed by the lungs, kidneys, and other organs. The use of scolicidal agents was reported in 117 studies, with hypertonic saline being the most frequently used. The mean operating time was 110.16 ± 6.50 minutes, and the mean time of hospital stay was 4.77 ± 0.35 days. Four postoperative mortalities and 291 complications, including biliary leakage, infection, and prolonged air leak were reported. Recurrence was noted in 79 patients, primarily following PAIR procedures.Conclusion: Minimally invasive approaches for hydatid cyst treatment, particularly laparoscopic and thoracoscopic procedures, demonstrate significant benefits such as reduced hospital stays, shorter operation times, and lower complication rates compared to open surgery. However, the higher recurrence rate associated with PAIR necessitates careful patient selection and follow-up. Continued research and clinical trials are essential to optimize these techniques and improve patient outcomes.