Hydatid Disease of the liver: Discase stage specific, multimodal treatment regimen

Abstract

Until today, surgery remains the treatment of choice for hydatid liver disease. However, new insights into the natural course of the disease and treatment alternatives are known. Since 1998 we have treated all patients with hydatid disease of the liver according to a disease stage specific, multimodai treatment regimen. The present study compares this new interdisciplinary approach with the surgical results from 19861997. Methods: Ultrasonographic classification of cyst morphology and activity (WHO grade 1-3) is mandatory for a stage adapted therapy: Calcified cysts (WHO 3) are inactive and need no treatment. Uncomplicated cysts (WHO 1 + 2) are pnw~arily treated with albendazole with subsequent sonographic controls. In case nf persisting activity and progression of the cyst we performed an endocystectomy with instillation of ethanol or in case of large cystobiliary fistula a liver resection. All complicated cysts were treated surgically. Results: Since 1998 we have screened 37 patients with hydatid disease. 12 were inactive and have been observed (32%). 25 were primarily treated with albendazole (67%), and in 19 of those (76%) cyst involution has been observed sonographically (16) or avitality directly proven by puncture (3). Only 6 patients (16%) needed surgery for cyst complications. So far recurrence rate and mortality are zero and no reintervention was necessary. 3 temporary biliary fistulas have been observed postoperatively, and the overall complication rate of all patients was low (8%). 67 cases with hydatid disease were treated surgically between lgl86-1997 (58 endocystectomies, 9 resections). Postoperatively we observed local complications (bile leakage, bilioma, hematoma, abscess) in 14 cases (21%). Recurrence was observed in 3 patients (4%). However, 43 of all treated cysts were calcified (64%) and would not be treated surgically anymore, as they are inactive. Conclusions: The new stage specific treatment regimen for hydatid disease lowers the number of necessary operations and at the same time morbidity. This therapeutical concept should he ideally performed by an expert team (infectious diseases, radiology, surgery) with a regular follow-up of all patients.