title: More than 25 years of surgical treatment of hydatid cysts in a nonendemic area using the "frozen seal" method.
abstract: BACKGROUND
  Hydatid disease of the liver remains endemic in the world and is an imported disease in The Netherlands. The aim of this study was to evaluate the treatment and outcome of surgically treated patients for hydatid disease in a single center in The Netherlands.
  
  
  METHODS
  This retrospective study included 112 consecutive patients surgically treated for hydatid disease between 1981 and 2007. The primary outcome was relapse of the disease. Secondary outcomes were infections, complications, reoperations, length of hospital stay, and mortality.
  
  
  RESULTS
  In all cases, echinococcosis was diagnosed by computed tomography or ultrasonography (US). Serology (enzyme-linked immunosorbent assay, immunofluorescence) confirmed the diagnosis in 92.9%. Most of the cysts were seen only in the liver (73.5%). All cysts were operated on with the frozen seal technique. Relapse of disease was seen in 9 (8.0%) cases. Five (4.5%) required surgical treatment at a later stage. Twenty (17.9%) complications were recorded. Four (3.6%) needed radiological drainage and three (2.7%) a reoperation. Follow-up was performed with US and/or serology at a mean of 24 months (range 0.5-300 months). All but one complication were seen in the liver-operated group, this proved not to be of statistical significance (P = 0.477). Patients with complications stayed significantly longer in hospital than did the patients without complications (P < 0.001). No mortality was observed in this study.
  
  
  CONCLUSIONS
  The present study suggests that the frozen seal method of surgery for hydatid disease is safe and effective. Future studies are needed to prove its position in the treatment of hydatid disease as new developments show promising results.
authors.affiliation: Department of Surgery, Maastricht University Medical Center, P. Debeylaan 25, Maastricht, The Netherlands. jan@stoot.com
authors.forename: J H M B
authors.initials: JH
authors.lastname: Stoot
authors.forename: C K
authors.initials: CK
authors.lastname: Jongsma
authors.forename: I
authors.initials: I
authors.lastname: Limantoro
authors.forename: O T
authors.initials: OT
authors.lastname: Terpstra
authors.forename: P J
authors.initials: PJ
authors.lastname: Breslau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003452:Cryosurgery / Q000379:methods*; D004444:Echinococcosis, Hepatic / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome