[Hepatic echinococcosis: radical or conservative surgical treatment]

Hydatid liver disease remains an actual medical and social problem for Bulgaria as an endemic region. Because of the lackage of medicines with satisfactory therapeutic effect the surgical treatment is still the treatment of primary importance.

The aim of this study was too check the correctness of the following hypothesis: "Radical surgical procedures on hydatid liver disease have lower rates of morbidity and mortality compared to conservative ones".

In order to achieve the above mentioned aim we analysed the results of 361 patients with hydatid liver disease (267 (74%) of whom retrospectively and 94 (26%) prospectively), treated at the Clinic of General, Liver and Pancreatic Surgery during the period 1st, Jan., 1985-1st, Jan., 2001. The patients were divided in two main groups: 102 (28.25%) of them received radical surgical procedures and 250 (69.25%)--conservative ones. Nine of the patients (2.50%) had multiple echinococcal cysts and received surgical procedures of both types. That's why the results of those patients did not correspond to the aim of the study and they were not included in it. The analysis consisted of a comparison between the two main groups according to several criteria: sex, age, location and average size of the cysts, postoperative complications, reoperations, mean postoperative stay at hospital and mortality rate.

There was a prevalence of the female in the ratio male/female in the group of patients who received a radical procedure. The location of echinococcal cysts in the left hepatic lobe was found to be more frequent. In the group of radical surgical operations the postoperative morbidity and mortality rates were lower and the postoperative stay at hospital was shorter, compared to the group of conservative procedures.

Radical surgical procedures showed better postoperative results. But those procedures had to be performed only on patients who had certain indications and according to criteria described in surgical literature. The proper surgical equipment and well experienced surgical team were the other important conditions for good outcome.