Surgical management and long-term outcome of complicated liver hydatid cysts caused by Echinococcus granulosus

Surgical management of symptomatic hydatid liver disease: experience from a Western centre

“…Diaphragmatic invasion was reported in 14% of complicated cysts within this same study. 7 Findings from the present study, as well as comparison to the literature, lend further support to the use of radical surgery, particularly formal liver resection, as a primary mode of therapy for complicated hydatid cysts. When this approach is deemed technically feasible and safe by experienced liver surgeons, it allows for the resection of both the cystic cavity and any area of fistulization.…”

“…Other series of liver surgery for hydatid disease have reported postoperative complication rates of 20%-49%. 3,4,[7][8][9][15][16][17] While the overall complication rate identified in this study (48%) was on the higher end of the previously published range, we argue that this is an acceptable morbidity rate. All recorded complications were classified as Clavien-Dindo grade 3a or less, with 76% of complications classified as grade 1 or 2.…”

“…[3][4][5][6] Over the years, a few contributions from Western centres have appeared, originating mostly in Europe. 7,9,10 In contrast, the North American experience with hydatid disease remains extremely limited owing to the rarity of this pathology and is restricted to rare series and occasional case reports. 8,11 To our knowledge, the present series represents the largest combined surgical experience with hydatid disease of the liver in North America.…”

“…Kilic and colleagues 19 also reported a direct association between maximal cyst size and the likelihood of biliary-cyst communication, with 7.5 cm being the cutoff with the best predictive value (sensitivity 79%, specificity 73%). Chautems and colleagues 7 further reported that 71% of patients with complicated cysts were found at surgery to have a cyst-biliary fistula, as defined by the visualization of an open bile duct following removal of a cyst. Furthermore, this group also identified daughter cysts within the common bile duct in 50% of patients, who were treated by choledochotomy, clearance and T-tube placement.…”

“…[3][4][5][6] In contrast, liver surgeons working in Western centres -particularly North American hospitals -can be expected to treat only a handful of such patients over the course of their careers. [7][8][9][10][11] In this context, it becomes particularly important to define surgical treatment strategies that are specific to the expertise of Western liver surgeons, which is lacking in the literature. We sought to review a single North American tertiary care centre's experience with patients who underwent liver surgery for hydatid cysts of the liver.…”