2 Case Reports in Gastrointestinal Medicine Figure 1: CT after 3 month course of albendazole and praziquantel. Table 1: Gharbi classiﬁcation of hepatic echinococcal cysts. Type I Type II Type III Type IV Type V Pure ﬂuid Fluid collection, spilt-wall ﬂoating membrane Fluid collection with septa, daughter cysts, and honeycomb image Heterogeneous echographic pattern Reﬂecting thick walls in the cyst cavity for 30 minutes per cycle to ensure complete killing of organisms. The cyst was then opened and a portion of the cyst wall excised using a harmonic scalpel and endo- GIA stapler with 2.5 mm vascular loads (Figures 5 and 6). A “double bag” technique was used to remove the excised cyst wall and debris, which were placed into an Endo CATCH bag and a Lapsac Surgical Tissue Pouch prior to being removed from the abdomen. An argon beam coagulator was then used on the entire remaining cyst wall. A Yankauer sucker was placed through the midepigastric port site, to aid in irrigation of the abdomen with a Clorpactin solution. A 10 French ﬂat Jackson-Pratt drain was placed in the cyst bed. The patient was discharged on postoperative day three with the drain, which had collected a small amount of bilious ﬂuid. The drain was removed after seven days. Pathology showed degenerating stage cysts without any living forms of E. granulosus. The infectious disease service recommended 28 more days of albendazole. At six-month followup, the patient remained asymptomatic and disease-free. 3. Discussion Surgery is the primary treatment for echinococcal disease. However, controversy still surrounds the preoperative med- ical treatment and type of operative procedure. The role of preoperative endoscopic retrograde cholangiopancreatogra- phy (ERCP) continues to be debated, with proposed beneﬁts including preoperative deﬁnition of cystobiliary relation- ships, treatment of cholangitis and biliary obstruction, and possible deﬁnitive treatment in cases of intrabiliary rupture. In one study, ERCP was reported to be safe method to treat biliary complications of hepatic hydatidosis before and Trocar placement 2 4 3 1 Figure 2: Trocar placement. Figure 3: Cyst surrounded by hypertonic saline-soaked pediatric laparotomy pads. Figure 4: Aspiration of cyst contents and instillation of hypertonic saline.