External drainage of the hepatic post hydatid remnant cavity

The surgical management of the hepatic post hydatid remnant cavity includes conservative and radical methods. External drainage of the remnant cavity (with or without cavity-minimizing) is a simple conservative method that can be safely performed, and can be associated with endoscopic papillo-sphincterectomy (EPS) in case of cysto-biliary fistula.

A retrospective study was performed on 112 patients operated in the Department of Surgery, "Caritas" Clinical Hospital, Bucharest between Jan 1997 and Feb 2007. Cavity was drained and the completely extraperitoneal approach for exteriorizing the drain was preferred, an original method conceived and put into practice by Prof. Dr. Burlui, using as pathway the round ligament, more precise the hepato-umbilical territory.

The mean hospital stay was 12 days, and follow-up till complete recovery was performed by clinical, ultrasound, CT-scan and X-ray contrast on the drainage tube. The drainage of the remnant cavity was maintained a mean period of 55 days (ranging 20 to 80), in accordance with the X-ray contrast control on the drainage tube. The postoperative morbidity was acceptable (remnant cavity infection was registered in 11% of the cases). Neither reintervention, nor mortality was registered.

the study shows that external drainage of the hepatic post hydatid remnant cavity can be applied in most of the parasite locations, especially for the central segments, with no hepatic parenchyma sacrifice, while total cavity fibrosis is achieved in a mean period of 55 days. This way we avoid a risky and laborious procedure (the anatomic or non-anatomic removal of a variable amount of normal hepatic tissue).