# Medical, Surgical, and Combined Approaches in Pediatric Hydatid Liver Disease: A Systematic Review

## TL;DR

This review compares medical, surgical, and combined treatments for liver hydatid disease in children, finding that treatment success depends on cyst size and that minimally invasive methods are beneficial.

## Contribution

The study introduces a personalized treatment algorithm for pediatric hydatid liver disease based on cyst characteristics like size and complexity.

## Key findings

- Small cysts (<5 cm) respond well to albendazole monotherapy with high success rates.
- Laparoscopic surgery offers shorter hospital stays and reduced analgesic use compared to open surgery.
- Omentoplasty is more effective than tube drainage for managing residual cavities after surgery.

## Abstract

Background: Hydatid disease poses unique management challenges in pediatric populations due to developing anatomy and growth considerations. This systematic review evaluates the efficacy and safety of medical, surgical, and combination therapies for pediatric hydatid liver disease. Methods: A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Library from inception to January 2025 identified studies investigating treatment outcomes in pediatric hydatid liver disease. Data was synthesized through qualitative analysis of treatment effectiveness, complications, and patient outcomes. Results: Fifteen studies were included, comprising controlled trials, cohort studies, and cross-sectional studies. Treatment efficacy correlated significantly with cyst size: small cysts (<5 cm) responded well to albendazole monotherapy (88.3–97.6% success at 6–12 months); medium-sized cysts (5–6 cm) benefited from percutaneous interventions (PAIR) with 97.1% technical success; large cysts (>6 cm) required surgical management. Laparoscopic approaches demonstrated advantages over open surgery, including shorter hospitalization (5.6 ± 2.2 vs. 12.1 ± 1.5 days) and reduced analgesic requirements. Omentoplasty emerged as superior for residual cavity management with fewer complications than tube drainage approaches. Conclusions: This review supports personalized treatment algorithms based primarily on cyst characteristics. The findings recommend standardized protocols incorporating cyst size, location, and complexity as key decision points, with expanded access to minimally invasive techniques. Future research should focus on prospective comparative studies with standardized outcome measures.