A novel minimally invasive approach for hepatic hydatid cyst – Percutaneous aspiration injection reaspiration using 5-mm laparoscopic trocar

Hepatic hydatid cysts are traditionally managed with antihelminthic coverage and definitively by surgical methods or Percutaneous Aspiration Injection Reaspiration (PAIR). Surgical methods of management include laparoscopic or open techniques like excision or pericystectomy, marsupialisation, omentoplasty or partial hepatectomy. In thick walled, intraparenchymal and posteriorly situated hydatid cysts which are not amenable to conventional PAIR or laparoscopic techniques, our modification of PAIR can be useful. Under USG guidance, 5mm laparoscopic trocars are inserted into the cyst and aspiration, injection of scolicidal agent and reaspiration is done using a laparoscopic suction cannula. Drain is left in situ to ensure complete drainage. This modification of PAIR is suitable for a subset of patients who can benefit from this minimally invasive method. This prevents them from undergoing open surgery which is associated with a lot of morbidity.