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A Continuing Surgical Problem

Michael C. Safioleas, MD, PhD; Evangelos P. Misiakos, MD; Maria Kouvaraki, MD; Michael K. Stamatakos, MD; Christine P. Manti, MD; Evangelos S. Felekouras, MD

Arch Surg. 2006;141:1101-1108.

Hypothesis  To study the results of different surgical strategies in the treatment of liver hydatid disease.

Design  A retrospective study of 287 patients.

Setting  A university hospital in Athens, Greece.

Patients  Two hundred eighty-seven patients with liver hydatid cysts treated surgically 1977-2004. The cysts were located in the right hepatic lobe in 192 cases, in the left lobe in 66 cases, and in both lobes in 29 cases. Eleven patients had concomitant cysts in other organs and 12 patients had multiple intra-abdominal cysts.

Results  All patients were treated surgically. Surgical procedures included external drainage, simple closure, marsupialization, partial cystectomy with omentoplasty, radical procedures, laparoscopic drainage, and radiofrequency ablation. The first 3 techniques carried a higher complication rate (36.5%) compared with the other techniques (17.85%; P<.05). However, omentoplasty and external drainage carried a higher recurrence rate (7.42% overall), as compared with radical procedures (3.22%).

Conclusion  Omentoplasty and radical procedures carry a lower complication rate compared with the formerly used marsupialization and external drainage. Conservative techniques, such as omentoplasty and/or other procedures, offer an effective control of hepatic hydatidosis and are preferred over radical procedures, when possible.

Author Affiliations: 2nd Department of Propedeutic Surgery (Drs Safioleas, Kouvaraki, and Stamatakos); Apolloneion Medical Center (Dr Misiakos); Aglaia Kyriakou Children's Hospital, Department of Microbiology (Dr Manti); and the 1st Department of Surgery, University of Athens, School of Medicine, Athens, Greece (Dr Felekouras).

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