However, it has recently been reported that PAIR is the accepted treatment of uncomplicated liver hydatid cysts in the stages of CE1 and CE3a. The controversy refers to the disadvantages of this procedure, since it can cause anaphylactic shock, death, and intraperitoneal spillage while performing puncture. Although this procedure is safe, effective, cheap and easy to perform, it is controversial from the perspective of the association of surgeons. This procedure was first presented by Mueller in 1985. The PAIR procedure is considered one of the noninvasive treatments. Open surgery, which is used for a complete removal of cysts, is a formal and traditional procedure among the surgeons for treating this disease. After diagnosing this disease, the physician needs to consider an approach from three known treatments including open surgery, PAIR (Puncture, Aspiration, Injection and Re-aspiration) and laparoscopic surgery (Lap) for hydatid liver cysts. To diagnose this disease we need to combine some techniques such as imaging, histopathology, nucleic acid detection, and serology. This disease is much more common in endemic regions of countries including Asia, the Middle East, Australia, Mediterranean countries, Europe, and South America and the rate of incidence is annually more than 50 out of 100,000 persons according to the report of the World Health Organization (WHO). Being asymptomatic is one of the dangerous characteristics of this disease, so the size of the cysts can be increased and after many years they can rupture, which results in anaphylactic shock.

The liver is the most common organ which is infected by this disease (50вЂ“70%) the second most common organ after the liver is the lung (20вЂ“30%), and the other organs less commonly affected are the spleen, kidneys, heart, bones, central nervous system and other organs. One of the global diseases threatening human life is hydatid disease, which is caused by tapeworms of the species Echinococcus granulosus. The PAIR procedure is superior to laparoscopy due to having a higher cure rate and lower complication and mortality rates however, the latter has a lower recurrence rate. Conclusions: This study shows promising trends toward an advantage of PAIR procedures in treatment of liver hydatid cyst in comparison with laparoscopic procedures. Moreover, EggerвЂ™s tests for determining publication bias and heterogeneity tests were also performed. However, the recurrence rate is low in laparoscopic approaches. The meta-analysis and the forest plots of the two procedures show that the PAIR approach is superior in terms of cure, complication, and mortality rates compared with the laparoscopy technique. In this meta-analysis study, a random effect model of correlations of outcomes (postoperative complications, mortalities, recurrences, and cure rates) of PAIR and laparoscopy procedures was used. Results: Fifty-seven studies including a total of 2832 patients (PAIR group n = 1650 and laparoscopic group = 1182) were analyzed. The outcomes of laparoscopic and PAIR procedures include the rates of cure, postoperative complications, recurrences, and mortality, which were extracted, assessed, and used as their corresponding effect sizes.

Material and methods: We designed descriptive Boolean queries to search two databases, PubMed and Scopus, to derive the articles published in the period of January 2000 to December 2016 in order to evaluate the outcomes of these research articles. In this study, a systematic review and meta-analysis were carried out in order to evaluate the pros and cons of both PAIR (Puncture, Aspiration, Injection, Respiration) and laparoscopic techniques by considering the outcomes of liver hydatid cysts. Introduction: There is an academic debate over surgical treatments of liver hydatid cyst disease.

Comprehensive meta analysis excel