Does primary surgical management of liver hydatid cyst influence recurrence?
OBJECTIVE
Hydatid disease is still a major health problem in sheep-raising areas. Surgery remains the basic treatment for liver hydatid cyst (LHC). However, recurrences can occur after all therapies. Surgery for recurrence of LHC becomes technically more difficult with higher rate of morbidity and mortality. The aim of this study was to determine perfective factors associated to hepatic recurrence after LHC surgery and to propose and discuss postoperative follow-up schedules.


METHODS
It is a retrospective cohort study of 672 patients with LHC treated at the surgery department "A" at Ibn Sina University Hospital, Rabat, Morocco, from January 1990 to December 2004. Recurrence rates have been analyzed by the Kaplan-Meier method for patients undergoing surgery.


RESULTS
Fifty-six patients (8.5%) had LHC recurrence after surgery. There were 34 females (60.7%) and 22 males (39.3%). Median duration of recurrence's diagnosis was 24 months (interquartile range: 10-48 months). Recurrence's risk was 2.3% +/- 0.6% at 1 year and 9.1% +/- 1.3% at the 10th year. The history of LHC (hazard ratio, 2; 95% confidential interval, 1.13-3.59) and three cysts or more (hazard ratio, 3.8; 95% confidential interval, 2.07-6.98) was an independent risk factor for recurrence.


CONCLUSIONS
We think that the surgeon's practice and experience are the most important to success the surgical treatment. It prevents complications and recurrences.
El Malki
Hadj Omar
HO
Surgery Departement A Ibn Sina Hospital, BP 2151 Salé, Bab Chaâfa, Salé, Maroc, Morocco. oelmalki@hotmail.fr
El Mejdoubi
Yasser
Y
Souadka
Amine
A
Zakri
Belkacem
B
Mohsine
Raouf
R
Ifrine
Lahcen
L
Abouqal
Redouane
R
Belkouchi
Abdelkader
A
D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D004444:Echinococcosis, Hepatic / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
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