Study of the Radical vs. Conservative Surgical Treatment of the Hepatic Hydatid Cyst: A 10-Year Experience

Abstract

The hepatic hydatid cyst is a major health problem in endemic areas. Surgery is still the best choice for the treatment of hydatid cyst of the liver. There is controversy regarding efficacy of radical versus conservative surgical approaches. In this study, we aimed to evaluate the two surgical methods in patients treated for the hepatic hydatid cyst. This is a retrospective review of the medical records of 135 patients who underwent surgery for the hepatic hydatid cyst from 1993 to 2003. Surgery comprised conservative methods (evacuation of the cyst content and excision of the inner cyst layers) and radical methods (total excision of the cyst and removal of its outer layer). One hundred thirty five patients underwent liver surgery. Conservative surgery was performed for 71 (53%), whereas, the remaining 64 patients (47%) underwent radical surgery. Local recurrence rate of the cysts was lower in the radical versus conservative surgery group and the mean length of hospital stay was shorter in the radical surgery group. Radical surgery of the hepatic hydatid cyst may be the preferred treatment because of its low rate of local recurrence, as well as short hospital stay.

Radical versus conservative surgical treatment of liver hydatid cysts

“…The mortality rate was similar to that reported in the literature (1·2 per cent, ranging from 0 to 6·5 per cent). There was no statistical difference in overall morbidity or deep abdominal complications between the conservative and radical groups, and rates were in the range reported in the literature (10–29·5 per cent).…”

“…Patients with either of these were excluded from the present study. This may partly explain differences in recurrence rates compared with published values for the conservative approach to treatment of liver hydatid cysts. These studies reported a higher recurrence rate for the conservative surgical approach.…”

“…Some authors have reported high recurrence rates after a conservative surgical approach. This may be due to viable material left on the outer surface of the pericyst (exogenous vesiculations), or the surgeon's skill and experience.…”

“…The conservative approach aims to unroof the cyst after evacuating its contents combined with one of various procedures to manage the residual cavity. In most recent publications, comparisons between radical and conservative techniques have been controversial. With a limited number of randomized studies available, authors have defended their preferred therapeutic option based on small comparative retrospective series, with non‐matched groups.…”

“…With a limited number of randomized studies available, authors have defended their preferred therapeutic option based on small comparative retrospective series, with non‐matched groups. In this context, recurrence of liver hydatid cysts has been one of the most commonly used endpoints to evaluate outcomes.…”