Surgical management and long-term outcome of complicated liver hydatid cysts caused by Echinococcus granulosus.
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.
Chautems
Roland
R
Department of Surgery, Clinic of Visceral Surgery,University Hospital of Geneva, Switzerland.
Bühler
Leo H
LH
Gold
Benjamin
B
Giostra
Emile
E
Poletti
Pierre
P
Chilcott
Michael
M
Morel
Philippe
P
Mentha
Gilles
G
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