title: Surgical management and long-term outcome of complicated liver hydatid cysts caused by Echinococcus granulosus.
abstract: BACKGROUND
  The aim of this retrospective study was to evaluate clinical presentation and long-term outcome of patients treated surgically for complicated liver hydatid cysts.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Clinic of Visceral Surgery,University Hospital of Geneva, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Chautems
authors.forename: Leo H
authors.initials: LH
authors.lastname: Bühler
authors.forename: Benjamin
authors.initials: B
authors.lastname: Gold
authors.forename: Emile
authors.initials: E
authors.lastname: Giostra
authors.forename: Pierre
authors.initials: P
authors.lastname: Poletti
authors.forename: Michael
authors.initials: M
authors.lastname: Chilcott
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
mesh_terms: D004443:Echinococcosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D048209:Echinococcus granulosus; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000469:parasitology / Q000601:surgery; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome