A 15-year experience (1988-2003) in the management of liver hydatidosis in northwestern Greece.
Hydatid disease (HD) is a parasitic infection often caused by the larvae of Echinococcus granulosus and rarely by Echinococcus multilocularis in endemic areas. This study aims to emphasize the perioperative administration of anthelmintic therapy over the different surgical procedures aimed at curing HD, because radical resection remains the only potentially curative treatment for hepatic echinococcosis. From October 1988 to September 2003, a total of 140 patients with echinococcal disease were studied: 125 presented with liver HD and 15 with extrahepatic echinococcus cysts (79 men and 62 women; median age, 47.8 years). Right hypochondriac pain, hepatomegaly, and dyspeptic complaints were the major symptoms, whereas cholestatic jaundice and itching were observed in 37 patients (28%). Ultrasound scan and computed tomography scan were performed in all patients preoperatively. The initial diagnosis was confirmed in all cases postoperatively by histological and anatomo-pathological examinations. All patients were given albendazole preoperatively for 5-7 days (10 mg/kg), continued for 4-6 weeks postoperatively in case where the protoscoleces were viable. The majority of the patients presented with one solitary cyst (68%), whereas 45 of the remaining (32%) presented with multiple cysts (two to four). The mean diameter of the cyst was 7 cm. One hundred thirty patients (93%) presented for regular follow-ups, and the median follow-up period was 52 months (range, 23-78 months). In conclusion, surgical treatment is indicated for liver HD because the rate for a definitive cure of the disease is high, and complications and recurrence risk is low. Albendazole treatment should preferably be administered perioperatively and always after R1 resection.
Koulas
Spyridon G
SG
Department of Surgery 'G. Hatzikosta' General Hospital, Ioannina, Greece. skoulas@freemail.gr
Sakellariou
Aekaterini
A
Betzios
John
J
Nikas
Konstantinos
K
Zikos
Nikos
N
Pappas-Gogos
George
G
Tsimoyiannis
Evangelos C
EC
D015766:Albendazole / Q000008:administration & dosage; D000871:Anthelmintics / Q000008:administration & dosage; D004444:Echinococcosis, Hepatic / Q000175:diagnosis* / Q000469:parasitology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged
D000871:Anthelmintics; D015766:Albendazole