Surgical management and long-term outcome of complicated liver hydatid cysts caused by Echinococcus granulosus

• Published in: Surgery Vol. 137; no. 3; pp. 312 - 316
• Main Authors: Chautems, Roland, Bühler, Leo H., Gold, Benjamin, Giostra, Emile, Poletti, Pierre, Chilcott, Michael, Morel, Philippe, Mentha, Gilles
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.03.2005; Elsevier
• Subjects: Biological and medical sciences; Diseases caused by cestodes; Echinococcoses; Echinococcosis - diagnostic imaging; Echinococcosis - mortality; Echinococcosis - surgery; Echinococcus granulosus; Follow-Up Studies; General aspects; Helminthic diseases; Humans; Infectious diseases; Liver - diagnostic imaging; Liver - parasitology; Liver - surgery; Medical sciences; Morbidity; Parasitic diseases; Postoperative Complications - mortality; Recurrence; Retrospective Studies; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome; Prognosis; Plathelmintha; Hepatic disease; Cestoda; Long term; Medicine; Clinical management; Treatment; Surgery; Helmintha; Digestive diseases; Complication; Evolution; Invertebrata; Echinococcus granulosus
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2004.09.004

The aim of this retrospective study was to evaluate clinical presentation and long-term outcome of patients treated surgically for complicated liver hydatid cysts. Eighty-four patients with liver hydatid cysts underwent an operation at the Geneva University Hospital between 1980 and 1999. Clinical presentation, postoperative morbidity, mortality, and long-term recurrence rate were evaluated. Among the 84 patients with liver hydatid disease, 35 patients (41%) presented complicated cysts (ie, cysts that had developed a fistula into adjacent structures or organs). In most patients, the fistula communicated with the biliary tree (n = 25), but we also observed communication with the right lung (n = 3), the right diaphragm (n = 2), liver parenchyma (n = 1), and peritoneal cavity (n = 1). Complete removal of the cystic disease was possible in 24 of 35 patients (70%). In 11 patients, fragments of cysts were not removed because of their location adjacent to main vessels. Postoperatively, 8 patients (23%) developed a severe complication (grade II and III). There were no postoperative deaths, and no recurrences of hydatid disease were observed with a median follow-up of 8.6 years (complete follow-up was obtained in 69% of patients). Complicated liver hydatid disease is frequent and was observed in almost half of patients operated for liver hydatid cysts at our center. Using a surgical strategy aimed at complete removal of cystic and pericystic tissue with simultaneous treatment of the fistulous tract, we observed 23% postoperative morbidity, no mortality, and no recurrence of disease with a median follow-up of >8 years.