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Prevention of Complications and Recurrences

Christos A. Pissiotis, MD; John V. Wander, MD; Robert E. Condon, MD

AMA Arch Surg. 1972;104(4):454-459.

Abstract
Eleven cases of hepatic and hepatic-pulmonary echinococcosis illustrate both the complications of the disease and modern surgical treatment. Complications encountered were spread of disease, persistent fistulas, severe wound infection, severe shock probably due to the use of formaldehyde for cyst injection, and death after lobectomy for a recurrent cyst. Principles of effective surgical treatment derived from this experience are as follows: Avoid percutaneous needle puncture, biopsy, or aspiration of any cystic mass of the upper part of the abdomen. Obtain hepatic scans and arteriograms to outline the dimensions of the cysts and to guide incision and access to the lesions. Meticulously isolate the operative field with multiple layers of surgical packs. Hypertonic saline for cyst injection is as effective as other agents. Radical resection is the only effective therapy for large cysts.

Author Affiliations
Iowa City; Chicago; Iowa City

From the departments of surgery of the University of Iowa College of Medicine, Iowa City (Drs. Pissiotis and Condon), and of the Abraham Lincoln School of Medicine, Chicago (Dr. Wander).

Footnotes
Accepted for publication Dec 7, 1971.

Read before the 79th annual meeting of the Western Surgical Association, Portland, Ore, Nov 19, 1971.

Reprint requests to Department of Surgery, University Hospitals, Iowa City 52240 (Dr. Condon).

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