Hepatic hydatidosis - surgical and endoscopic treatment

Abstract

Aim Cystic hepatic hydatidosis, caused by the tape-worm Echinococcus granulosus, is an ancient disease, endemic in sheep rearing areas. Despite improvement in medical treatment, it remains a surgical disease for the good risk patient and may represent a complicated and challenging problem in liver surgery. However, controversy still exists regarding the appropriate surgical technique. Methods We present 200 patients, suffering from cystic hepatic hydatidosis, we operated on consecutively from 1985 to 2001, applying the same operative principles consisting in wide capsectomy and drainage. This surgical technique is described in details. Results There was mortality of 0.5% and postoperative complications of 14%, most of them related to bile leaks. Endoscopy was selectively performed in bile fistulas, considering the volume and duration of biliary drainage. They all healed and no re-operation was required. There was recurrence in 11 of 115 patients (10% of the total) who were subjected to follow up, ranging from four to 20 years. Conclusion Drainage operations, when properly performed, present excellent results regarding total extirpation of the parasite with few postoperative complications and few late recurrences, not requiring more aggressive surgical approaches. Endoscopy may be successfully applied for treating long lasting biliary fistulas.