title: Treatment of hydatid disease of the liver. Evaluation of a UK experience.
abstract: BACKGROUND
  Hydatid disease of the liver though endemic in many countries, is rare in the UK. We evaluated a 16-year experience of treating hydatidosis using a management protocol combining surgery with anti-scolicidals.
  
  
  METHODS
  There were 30 patients. 14 (47%) males, median age 41 (range 25-72) years, of whom 21 (70%) were symptomatic. Diagnosis was by serological tests and imaging. All had disease confined to the liver and received peri-operative anti-scolicidal drug therapy.
  
  
  RESULTS
  The initial 4 (13%) patients received praziquantel combined with albendazole for 2 weeks and the following 26 (87%) patients received two cycles of albendazole 400 mg twice daily for 28 days, with a 14-day break in between. However, 2 (7%) patients could not tolerate albendazole, one due to GI side effects and the other developed deranged liver functions. These 2 patients subsequently received praziquantel for 2 weeks. All patients underwent surgery. Subtotal cystectomy was carried out on 29 (96%) patients and 1 patient required a segmentectomy. Cystobiliary communications were identified in 15 (50%) of patients which were oversewn using fine absorbable sutures. Of these, 7 had the bile ducts decompressed using a T tube, with only 1 developing a post-operative bile leak. In comparison, 8 were not drained of which 6 leaked (p = 0.03). The median post-operative hospital stay was 8 days (range 5-24). Patients who developed post-operative bile leaks, however, needed prolonged abdominal drainage for a median of 21 days (range 18-24). Two (7%) patients developed histologically proven recurrent disease. The median follow-up was 56 months (range 3-87).
  
  
  CONCLUSIONS
  Surgery combined with anti-scolicidal therapy proved effective. Cystobiliary communications are common and, when identified, should result in the biliary system being drained, to avoid post-operative bile leaks.
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Silva
authors.forename: D F
authors.initials: DF
authors.lastname: Mirza
authors.forename: S R
authors.initials: SR
authors.lastname: Bramhall
authors.forename: A D
authors.initials: AD
authors.lastname: Mayer
authors.forename: P
authors.initials: P
authors.lastname: McMaster
authors.forename: J A C
authors.initials: JA
authors.lastname: Buckels
mesh_terms: D000328:Adult; D015766:Albendazole / Q000627:therapeutic use; D000871:Anthelmintics / Q000627:therapeutic use*; D001646:Bile; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D004322:Drainage; D004444:Echinococcosis, Hepatic / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011223:Praziquantel / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000871:Anthelmintics; D011223:Praziquantel; D015766:Albendazole