Radical Surgical Therapy of Abdominal Cystic Hydatid Disease: Factors of Recurrence

Abstract

A series of 74 consecutive patients (48 women, 26 men) were operated for abdominal hydatid disease between June 1949 and December 1995. The patients ranged in age from 15 to 81 years (median 49 years). In 69 cases only the liver was affected; two patients had concomitant extrahepatic disease (one spleen, one spleen and lung), and 3 had cysts in the spleen only. Cysts were multiple in 11 patients and calcified in 24. Conservative surgical procedures were used for 22 cysts in 20 patients [open partial (n = 3), open total (n = 6), closed total cystectomy (n = 9), marsupialization (n = 2), drainage (n = 2)] and radical surgical procedures for 72 cysts in 54 patients [pericystectomy (n = 41), wedge liver resection or hemihepatectomy (n = 25), splenectomy (n = 5), radical resection of a lung cyst (n = 1)]. Altogether 37 patients (50%) were given perioperative antihelmintic chemotherapy with mebendazole (18 patients) or albendazole (19 patients). Operative mortality rates were 5.0% after conservative surgery and 1.8% after radical surgery. Morbidity rates were 25.0% following conservative surgery and 24.1% following radical surgery. Antihelmintic therapy was well tolerated by all but five patients. All side effects were entirely reversible. Among the 74 patients, 60 (81.0%) were available for long-term follow-up (median 7.2 years; range 2.0-47.0 years). Recurrence of disease was seen in 9 of 60 patients at an interval of 3 months to 20 years from the first operation. The rate of recurrence was significantly lower after radical surgical procedures (p = 0.03) and after closed removal of the cyst (p = 0.04).

Echinococcus canadensis G7 (Pig Strain): An Underestimated Cause of Cystic Echinococcosis in Austria

“…This case shows very well that CE not only causes severe disease in humans and livestock-associated production losses in relatively poor countries, 1,16,17 but also possible death, even in countries with an excellent health system like Austria. 18 In general, a younger age at the time of diagnosis is correlated with an increased exposure to E. granulosus , 19,20 which seems to be an explanation for the younger median age of the Turkish (30 years) and the former YU originated patients (39 years). In contrast, the significantly higher median age of Austrian patients (55 years) may reflect the good hygiene conditions, veterinary control systems, and essential improvements in farming conditions over the last decades in Austria.…”

Safety of the Combined Use of Praziquantel and Albendazole in the Treatment of Human Hydatid Disease

“…In addition, as previously indicated medical treatment with albendazole before surgery allows relapses to be reduced. 36,37 Other anti-parasitic drugs have been tested in combination with benzimidazoles with a synergic action. Although there are no comparative randomized studies exploring treatment with albendazole in monotherapy versus combined therapy with albendazole plus praziquantel in patients without surgery, it appears that the combined therapy could improve the results obtained with albendazole alone.…”

Ambispective comparative study of two surgical strategies for liver hydatidosis

“…No consensus exists in the international literature regarding the optimal treatment for HDL [10,13,[17][18][19] . Possible therapeutic options are observation, anthelmintics, percutaneous aspiration, or surgery (conservative or radical).…”

“…Possible therapeutic options are observation, anthelmintics, percutaneous aspiration, or surgery (conservative or radical). Surgery is considered the therapy of choice [2,3,[8][9][10][11][17][18][19] .…”

“…The characteristics of the cyst (number, size and location), presence of complications related to the HDL, the patient's age and comorbidities, presence of new or recurrent disease, and the surgeon's experience in hepatic surgery condition decision-making with regard to selection of the technique [2-4, [9][10][11]17,19]. CS offers acceptable results, is easily performed at any center and on any cyst by surgeons with little experience in hepatic surgery, and has a low mortality rate and an appreciable morbidity rate, particularly biliary morbidity and recurrence [1,4,10,12,17,19] .…”