[Surgery and long-term follow-up of hepatic echinococcosis outside endemic regions].
The aim of the study was to characterize the therapeutic pathways in patients with echinococcal hydatids in an institution outside the endemic areas but with a high frequency of oncological hepatic surgery.


METHODS
44 patients with echinococcosis from 1987-1997 were reviewed. To evaluate the long-term results, clinical examination, chest x-ray, serology and liver ultrasound were performed. According to the study protocol 39 patients were evaluable. 89.7 % of the patients suffered from a primary disease, whereas 7.7 had a local recurrence and another 2.5 of patients showed a second site of manifestation after former operation. E. cysticus occurred in 82.5 %, E. alveolaris in 17.5 %.


RESULTS
In 66.7 % of all cases a resecting procedure (pericystectomy, atypic resection, regular and extended hemihepatectomy) was performed. One patient underwent an orthotopic liver transplantation and in 10 % the surgical procedure included only an open drainage of the cysts. A simple cystectomy was performed in 23 %. One patient died from multiple organ failure as a consequence of local bleeding complications. The overall complication rate was 38.5 %, including the postoperative death and 7.7 % reoperations. The complication rate following pericystectomy was much higher than after simple cystectomy. At the time of follow-up (median 66 months) no patient showed a recurrent disease.


CONCLUSIONS
Compared to reports from endemic regions the rate of resective procedures was much higher. The therapeutic strategy lead to excellent long-term results. Simple cystectomy should be preferred as pericystectomy showed a higher morbidity.
Schmidt-Matthiesen
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Klinik für Allgemein- und Gefässchirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. Schmidt-Matthiesen@em.uni-frankfurt.de
Schott
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O
Encke
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D000328:Adult; D004444:Echinococcosis, Hepatic / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D019353:Endemic Diseases; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007902:Length of Stay; D008297:Male; D008463:Mebendazole / Q000008:administration & dosage; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate
D008463:Mebendazole