Percutaneous treatment of pediatric WHO CE1 and CE3a hepatic hydatid cysts: comparison of giant and non-giant cysts.

objectiveTo evaluate the efficacy, safety, and clinical outcomes of percutaneous treatment in pediatric patients with World Health Organization (WHO) CE1 and CE3a hepatic hydatid cysts. MATERIALS: A total of 98 pediatric patients with WHO CE1 or CE3a hepatic hydatid cysts who underwent treatment using the Standard Catheterization Technique (S-CAT) between March 1, 2020 and March 31, 2026 were retrospectively evaluated. Demographic characteristics, cyst features (type, size, and location), pre- and post-treatment cyst volumes, major and minor complications, presence of cystobiliary fistula (CBF), catheter removal time, length of hospital stay, re-collection, and treatment-related interventions were recorded. Patients were categorized according to the presence of cystobiliary fistula and cyst size (giant vs. non-giant) for comparative analysis.

resultsAmong the 98 children included in the study, 51 (52.0%) were female, and the mean age was 12.8 ± 4.5 years (range, 4-18 years). Most cysts were located in the right hepatic lobe (85.7%, n = 84) and classified as CE1 (87.8%, n = 86). Cystobiliary fistula was detected in 19 patients (19.4%), and seven patients (7.2%) required papillotomy and common bile duct stenting due to persistent fistula. Spontaneous fistula closure time was 13.2 ± 3.85 days. Central cyst location was significantly more frequent in patients with fistula (68.4% vs. 27.8%, p < 0.001). Patients with CBF had longer hospital stay (4.6 ± 1.9 vs. 2.8 ± 2.2 days, p < 0.001) and longer catheterization duration (17.2 ± 6.5 vs. 3.9 ± 2.7 days, p < 0.001). Initial cyst volume was also higher in patients with fistula (309 ± 137 vs. 235 ± 108 cm³, p = 0.04). In multivariable logistic regression analysis, central cyst location and giant cyst status (> 10 cm) were identified as independent predictors of cystobiliary fistula, with approximately 4.5-fold and 8.5-fold increased risks, respectively. Giant cysts were present in 35 patients (35.7%). Compared with non-giant cysts, giant cysts had longer hospital stay (5.7 ± 3.6 vs. 3.1 ± 2.1 days, p < 0.001), longer catheterization duration (13.1 ± 8.8 vs. 5.3 ± 6.4 days, p < 0.001), and higher fistula rates (37.1% vs. 9.5%, p = 0.001). Mean follow-up was 17.9 ± 10.7 months (range, 12-48 months), and mean cyst volume reduction was 86.9%. Re-collection occurred in 5 patients (5.1%), and anaphylaxis in 6 patients (6.1%).

conclusionPercutaneous treatment of pediatric hepatic hydatid cysts appears to be a safe and effective treatment modality, resulting in substantial cyst volume reduction and favorable clinical outcomes during follow-up. However, giant cysts and central cyst location are independently associated with higher risk of cystobiliary fistula and prolonged hospitalization and catheterization duration. Due to the risk of anaphylaxis, procedures should be performed under general anesthesia with appropriate equipment and an experienced multidisciplinary team.