title: Complex hydatid cysts of the liver: a single center's evolving approach to surgical treatment.
abstract: In our study, we arbitrarily define complex hydatid cysts of the liver as either cysts with a diameter > or =10 cm, or as multiple and recurrent cysts. These types of cysts were then divided into two subgroups: giant cyst identified as a cyst with a diameter > or =10 cm, and complicated cyst as multiple, recurrent, abscessed cysts, or those resistant to conservative treatment. The aim of this study was to retrospectively analyze a series of 38 consecutive patients who underwent surgery for complex hydatid cysts over a period of 9 years at the same institute to determine the evolution of the surgical treatment and the risk factors for recurrence. Fourteen (36.8%) of these patients were women and 24 (63.2%) men (median age 48.1; range 16-71 years). The mean postoperative followup was 24 +/- 10.8 months. All patients were treated prophylactically with albendazole (10 mg/Kg/day) for 15 days preoperatively and for 2 months postoperatively. Partial cystectomy was performed in two cases (5.26%) and radical pericystectomy in 20 cases (52.63%). In 15 cases the patients underwent liver resection (39.47%): left hepatectomy was performed in eight cases (21.05%), and right hepatectomy in seven cases (18.42%). In one case, both wedge resection and pericystectomy were performed. There were no deaths and only one patient (2.63%) showed signs of recurrence at follow-up. Radical surgery is the most effective treatment for complex hydatid cysts. In our experience, partial or total pericystectomy virtually eliminated, over time, the need for hepatic resection.
authors.affiliation: Department of Abdominal and Transplantation Surgery, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy.
authors.forename: Ivan
authors.initials: I
authors.lastname: Botrugno
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gruttadauria
authors.forename: Sergio
authors.initials: S
authors.lastname: Li Petri
authors.forename: Davide
authors.initials: D
authors.lastname: Cintorino
authors.forename: Marco
authors.initials: M
authors.lastname: Spada
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Francesco
authors.forename: Dullio
authors.initials: D
authors.lastname: Pagano
authors.forename: Francesca
authors.initials: F
authors.lastname: Crino
authors.forename: Domenico
authors.initials: D
authors.lastname: Anastasi
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004444:Echinococcosis, Hepatic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult