Surgical treatment of hepatic Echinococcus granulosus

Abstract

IntroductionInfections caused by metacestode stage of the Echinococcus granulosus in humans result in disease named cystic echinococcosis.AimTo present the outcomes of patients treated surgically for cystic echinococcosis of the liver.Material and methodsOne hundred and nineteen patients treated in the period between 1989 and 2014 due to E. granulosus infection in the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw were selected for this retrospective study. Diagnostic protocol included imaging examinations, i.e. ultrasonography and computed tomography of the abdomen. Blood samples where used to proceed sequential enzyme-linked immunosorbent assay (ELISA) using Em2plus antigen as well as polymerase chain reaction (PCR) to detect E. granulosus.ResultsSurgery was the choice for treatment for almost all of the patients (98.3%). In 40 (34.2%) patients right hemihepatectomy, in 19 (16.2%) patients left hemihepatectomy, and in 21 (17.9%) patients bisegementectomy were performed. Postoperative complications occurred in 4 (3.4%) patients. In 3 patients biliary fistula requiring endoscopic treatment was observed, and 1 patient had subdiaphragmatic abscess successfully treated with drainage under ultrasound guidance. None of the patients died in the postoperative period, and the 1-, 5-, and 10-year survival rates were 100.0%, 90.9%, and 87.9%, respectively.ConclusionsSurgical treatment of the symptomatic cystic echinococcosis is the modality of choice for E. granulosus infection of the liver. Despite substantial development of diagnostic methods and new management opportunities, echinococcal infection still presents a challenge for epidemiologists, pharmacologists, and clinicists.

Surgical treatment of Abdominal Echinococcosis

“…The immunoblot or other immunodiagnostic tests could be indicated when IgG-ELISA test is inconclusive. 14 Treatment is based upon the WHO guidelines. There are no randomised clinical trials to date that could compare different treatment modalities and, accordingly, the strength of recommendations is moderate.…”

“…There is also a "watchful waiting" strategy that may be considered in uncomplicated and small lesions. 14 Junghanss et al, the idea of leaving uncomplicated, inactive cysts untreated and solely monitored over time follows the observation that a good proportion of cysts become spontaneously inactive without any treatment and such cysts are likely to remain stable over time. 15 PAIR technique stands for puncture, aspiration, injection and respiration.…”

Biliary fistula after liver hydatid cyst surgery: Is it a predictable complication?

“…In literature, there were many different biliary fistula rates. In a study with 117 patients, Patkowski et al reported biliary fistula in three patient (2.5%) [5]. Furthermore, Nooghabi et al reported 27.3% biliary fistula rate in 73 patients [6].…”

Coronary compression by supposed cardiac hydatid cyst: an unusual cardiac mass

“…Hydatid disease (cystic echinococcosis) is a rare parasitic infestation caused by the metacestode stage of Echinococcus granulosus that usually involves the liver and lungs [1]. Cardiac involvement is very rare (0.5–2%).…”