title: Complicated liver echinococcosis: 30 years of experience from an endemic area.
abstract: OBJECTIVE
  Although declining, cystic echinococcosis is still a serious public health issue in Greece. This study evaluated the clinical features, management, and short-term outcome of patients with complicated liver echinococcosis.
  
  
  METHODS
  A total of 227 patients who were operated on for 322 echinococcal cysts of the liver were retrospectively evaluated. Patients were divided into those with complicated disease (53.7%) and those with noncomplicated disease (46.3%). Intrabiliary rupture (34.4%), cyst infection (32.7%), and their combination (24.5%) were the most common complications. Demographic characteristics, previous hydatid cyst surgery, cyst multiplicity and location, presenting symptoms and signs, types of complicated disease, operative procedures performed, postoperative complications, and hospital stay were assessed.
  
  
  RESULTS
  Patient demographics and cyst characteristics demonstrated no significant difference between the two groups. The complicated disease group had significantly more pronounced clinical presentations and higher postoperative morbidity. Choice of surgical procedure depended upon cyst location and surgeon preference. Both conservative and radical procedures were performed, supplemented with additional management of the biliary tree when indicated.
  
  
  CONCLUSIONS
  Complicated liver echinococcosis demonstrates several distinct features that differentiate it from the noncomplicated disease. Frequently severe clinical manifestations, complexity of surgical management, and the increased postoperative complications characterize complicated liver echinococcal disease.
authors: Second Propedeutical Department of Surgery, School of Medicine, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors: N
authors: N
authors: Symeonidis
authors: T
authors: T
authors: Pavlidis
authors: M
authors: M
authors: Baltatzis
authors: K
authors: K
authors: Ballas
authors: K
authors: K
authors: Psarras
authors: G
authors: G
authors: Marakis
authors: A
authors: A
authors: Sakantamis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015766:Albendazole / Q000627:therapeutic use; D000871:Anthelmintics / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D004334:Drug Administration Schedule; D004444:Echinococcosis, Hepatic / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019353:Endemic Diseases; D005260:Female; D006115:Greece / Q000453:epidemiology; D006498:Hepatectomy; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000871:Anthelmintics; D015766:Albendazole
keywords: Hepatic echinococcosis; cyst suppuration; intrabiliary rupture; peritoneal rupture