Prospective study comparing cyst viability at surgery in order to standardise the preoperative albendazole therapy in patients with hepatic hydatid disease

Abstract

BACKGROUND:- Hydatid disease is a zoonotic disease having worldwide distribution, caused by the larval stage of parasite Echinococcus granulosus. Treatment options for hydatid disease includes medical and surgical methods, latter being the gold standard. In order to prevent abdominal dissemination of the disease during surgery, pre-operative chemotherapy has been used to render the cyst non-viable. However, these drugs, as like any other form of medications, have side effects, if used for prolonged period of time.

OBJECTIVES:- To assess the efficacy of albendazole(15mg/kg/day) over a period of 2 weeks and 4 weeks on the viability of protoscoleces; and to standardise the preoperative duration of albendazole therapy in patients with hepatic hydatid disease.

PARTICIPANTS:- Patients with hepatic hydatid disease attending the OPD and IPD of General Surgery SKIMS.

STUDY DESIGN:- Prospective comparative study.

METHODS:- The study was conducted at Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, India over a period of two years from August 2018 to July 2020. The study included 40 cases in the age group of 15 to 60 years, comprising 12 males and 28 females. Aim of our study was to compare the effect of albendazole on hydatid cyst viability. Patients were randomly divided into two groups, Group A and Group B. In group A, patients were subjected to 2 weeks albendazole therapy and those in group B were subjected to 4 weeks albendazole therapy, preoperatively.

RESULTS:- Of those patients who received albendazole therapy for 2 weeks, 5% patients had viable cysts (n=1 patient) at the time of surgery as compared to 0% patients with viable cysts in the group receiving albendazole therapy for 4 weeks. The patient who had viable cyst was found to have comorbidities and on retrospective analysis was found to be non-compliant to the drug therapy.

CONCLUSION:- We conclude that oral albendazole(15mg/kg/day) over a period of 2 weeks is safe and effective neo-adjuvant therapy in the management of hepatic hydatid disease, in young and otherwise healthy individuals. However, prolonged course of 4 weeks is advised for those with comorbidities and immunosuppressive state.