Improved results with pericystectomy in normothermic ischemia for hepatic hydatidosis

Pericystectomy is an excellent surgical procedure for the treatment of hepatic hydatidosis. However, until now, it was not a widely accepted procedure among surgeons because of the lack of literature regarding the details of the surgical technique. During the past years, hepatic hydatidosis has been treated by a majority of surgeons by marsupialization. Only recently, more surgeons have stopped using external drainage procedures in favor of hepatic resection and pericystectomy. In a previous study, we defined some of the criteria for resection of the liver and treatment of hepatic hydatidosis, analyzing the risks and benefits for this procedure. In the present study, we have defined the indications for pericystectomy and discussed the advantages and disadvantages. In a group of 31 patients, a total of 49 cysts were removed by pericystectomy. Some of the major problems related to surgical technique are described and discussed in detail with particular reference to the use of the Pringle maneuver. Clamping of the hepatic ileum, that in our experience never exceeded 20 minutes, has allowed good results--most of all in terms of decreased intraoperative bleeding, postoperative complications and operating time.