[Surgical treatment of hepatic echinococcosis--10-year experience]

Especially debatable remains the problem concerning the volume of the surgical treatment of hepatic echinococcosis. At present it varies from radical typical and atypical liver resections, through closed conservative approaches, to minimally invasive methods like PAIR or laparoscopic echinococcectomy.

The aim of the present investigation is to elucidate the problems, occurring during surgical treatment of hepatic echinococcosis and to offer adequate treatment-diagnostic algorithm. This retrospective study summarizes our 10-year experience in a number of debatable topics, concerning the surgical treatment of this socially significant disease.

To fulfill the aim, we performed a retrospective clinical study for a period of 10 years. One-hundred-forty-seven patients had been admitted to hospital and underwent surgical treatment for hepatic echinococcosis during that period. One-hundred were males (58%) and 47 (32%)--females. The age of the patients included in the retrospective study varies between 6 and 80 years--(mean age 39.1 +/- 8.9). In 19 patients we found multiple echinococcosis of the liver (2 to 7 cysts). Two cysts--in 7 patients, 3 cysts--in 6 patients, 4 cysts in 1 patient, 5 cysts in 2 patients, 6 cysts in 1 patient and 7 cysts in 2 patients. The right hepatic lobe is three times more frequently engaged than the left one--106 patients with right-sided localization (72.1%) compared to 41 with left-sided (27.9%). Combined echinococcosis is found in 14 patients. Concomitant engagement of liver and spleen is present in 2 patients, peritoneal dissemination--in 7 patients and accompanying lung cyst--in 6 patients. Echinococcectomy with capitonage of the residual cavity is performed in 126 patients, echinococcectomy with external drainage in 4 patients, atypical liver resection in 8 patients, echinococcectomy via thoracofrenectomy approach in 6 patients and combined surgical interventions with spleen removal in 3 patients. In their majority the complications are not serious and life-threatening or with permanent consequences to the patient. Severe complications demanding active surgical intervention occur in approximately 4% of the treated patients. Our results are comparable with the ones of leading national and foreign centers and confirm the correctness of our treatment. The average hospital stay is 12 days. We have no lethal cases for the study period.

Based on our experience, we consider that echinococcectomy with capitonage of the residual cavity and invagination of the fibrous rims is the method of choice for hepatic localization of the parasite. The above-mentioned surgical technique is characterized with low percentage of post-surgical complications, is well-tolerated from patients and relatively atraumatic and shows excellent long-term results. We consider more radical surgical methods, like atypical liver resections, appropriate in selected patients, ones with multiple echinococcosis and vast fibrous-altered areas of liver parenchyma. We find reasonable the obligatory adjuvant post-surgical treatment with Albendazole under parasitologist control, especially in cases of multiple and/or recurrent echinococcosis.