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Abstract

Introduction: Liver echinococcosis is still an endemic disease in Balkans. PAIR is actually considered the safest therapeutically approach for uncomplicated type I and II cysts, while surgery is indicated for type III or complicated cysts. It's commonly believed that radical surgery could be considered the most appropriate treatment for hydrated disease, but with higher risk of morbidity, much more for centrally located cysts, especially in low-resources hospitals.Aim of the study: According with the tendency in western countries and within a training project leaded by Veneto Region -Italy, we started in cooperation with the Division of Surgery of Peja Hospital Kosovo a prospective study to assess the safety and effectiveness of radical surgery also for centrally located cysts, when PAIR was contraindicated. Materials and Methods:From Feb 2006 to Apr 2010, 10 consecutive patients (6 Female, 4 males, mean age 31, 3± 14 yrs, range 8-54) with 16 cysts were treated for echinococcal liver disease in Surgical Division of Peja Hospital, Kosovo. All patients received Albendazole before operation and in the perioperative period. Medical therapy was discontinued the day after operation. One patient had recurrent echinococcal cysts after previous operation of partial cystectomy and T-tube placement in the biliary duct. Patients were classified to have peripherical (n=1) or centrally (n=9) located cysts when at least one of them was in close relationship with the main vascular and biliary structures. Other than laboratory tests, preoperative evaluation included in all patients abdominal ultrasound and CT scan.Results: Nine pts with 15 cysts underwent radical surgery and 1 patient underwent non radical operation (1 subtotal pericystectomy). Four of them had multiple cysts. Mean operative time was 236 min. Mean postoperative stay was 5, 2± 2, 52 days (range 3-10). No intra or postoperative complications were observed after radical surgery. A bile leak that healed spontaneously after 9 days occurred in patient with subtotal pericystectomy. Mean follow-up is longer than 3 years. Discussion: Therapeutic choices for echinococcal liver disease depend from factors related to patient, cyst, availability of resources and physician. Radical surgery is considered the treatment of choice because of complete elimination of the parasite and the residual cavity, minimizing the risk of recurrence. This approach, especially for central cysts, must be balanced with the risk of complications, but it's the preferred one in Centers with expertise in liver surgery and it was possible in 93% of cases in this series. In our experience mean operative time was prolonged because of meticulous dissections of cysts from surrounding tissue and vessels. It was always possible to dissect the main veins from pericystium, while portal triad structures were more often eroded by the cysts and needed to be sutured. Mean follow-up is more than 3 years and no recurrences were observed until now. Conclusion:Open radical surgery can be considered a reliable...