Follow-up problems and changes in obliteration of the residual cystic cavity after treatment for hepatic hydatidosis.

Abstract

In this prospective open clinical study, we investigated the problems that might arise during the obliteration of the residual cavity in hepatic hydatidosis. These problems might be related to the duration of the obliteration period and to the effects of omentoplasty on the residual cavity. We operated on 54 hepatic hydatidosis patients with cystodrainage and omentoplasty. We followed these patients for a period of 8 years after the operation. We used ultrasonography (US) to evaluate the obliteration of the cystic cavity; evaluations were made by serological tests as well (hemagglutination test, IHA, and IgE radioallergosorbent test, RAST). Most of the reductions in the size of the cystic cavity were observed within the first 30 days following the operation (69.7%). At the end of the first postoperative year, cystic cavity obliteration was not complete in 34 patients, and 5 of these cases had positive indirect IHA and IgE RAST tests for Echinococcus granulosus. These patients were treated with extension of albendazol therapy. In 2 of these 5 patients, obliteration of the cystic cavity was complete within 12 months; their serological tests became negative at 15 and 21 months, respectively. In the remaining 3 whose serological tests were still positive at the end of the first year, obliteration of the cystic cavity was complete by 27, 33, and 45 months respectively. Of these 3 patients, the tests became negative at 30 and 52 months for the first 2 patients; the last patient is still serologically positive although we have not determined any findings related to the recurrence of the cyst. Omentoplasty is the preferred method in the surgical treatment of hepatic hydatidosis. However, we should keep the following facts in mind while following these patients with US: the technique can be insufficient, the obliteration of the residual cavity takes time and can be misdiagnosed as a recurrence, and ultrasonographic appearances can mimic some other diseases whether they are benign or malignant. Moreover, follow-up studies should be complemented with the serological tests. Thus, all these steps will minimize a misdiagnosis and unnecessary reoperations for hepatic hydatidosis.