Surgical treatment of Abdominal Echinococcosis

Abstract

Background: Cystic Echinococcosis is a zoonosis with worldwide geographical distribution caused by dog tapeworm. Cystic echinococcosis most frequently involves only one organ by forming a solitary cyst. Hydatid disease commonly involves the liver (75%) and lungs (15%), followed by other regions of the body (10-15%). Multi-organ abdominal HD is the most serious form and is potentially fatal.Methods: It is a retrospective study for a duration of 3 years. The recorded data of all the patients undergoing treatment has been collected and analyzed.Results: A total of 30 patients were identified. Most common organ involved was liver followed by spleen, pancreas and kidney. Cysts are more commonly seen in right lobe. All the patients underwent surgical treatment. 17 patients underwent open surgery, while 13 patients were treated by laparoscopy. Cysto biliary communication was identified in 3 patients, all in laparoscopy and a primary closure was done. All the patients were started on albendazole 400 mg twice daily per oral at least 15 days prior to surgery and this treatment was continued for 3 months post-operatively.Conclusions: Hydatid disease is endemic in sheep farming and cattle farming areas of Asia. Most patients remain asymptomatic for years. Diagnosis is by imaging techniques. Echinococcal infection usually requires multimodality treatment and the best treatment is always individualized. Surgery along with anti-helminthic treatment holds the best curative measure at present.

Introductory Chapter: Overview on Echinococcosis

“…The surgical approach is aiming to parasite inactivation, evacuation of the endocyst with the prevention of contamination, germinal layer removal, and residual cavity management [18].…”

“…Radical surgery is the first therapeutic choice suitable for total excision of the entire parasitic lesion. Whenever possible, complete resection is required because radical surgical procedures are superior to conservative surgical methods and may cure definitively the patient [18].…”

“…Laparoscopy has several advantages including: better visualization of the peritoneal cavity and internal organs, prompt postoperative discharge, limited postoperative morbidity, and good esthetic outcomes [18].…”