Surgical treatment of extrahepatic intraabdominal hydatid cysts: A single-centre retrospective analysis

Cystic echinococcosis is a zoonotic disease caused by Echinococcus granulosus. Although Echinococcal cysts are most frequently located in the liver (59-75%), in rare circumstances they may develop in extra-hepatic locations. Because extrahepatic cysts are rare and lack the characteristic appearance of hepatic cysts, diagnosis can be challenging. In the present retrospective study, the medical records of 41 patients surgically treated for intra-abdominal extrahepatic hydatid cyst disease were analysed to collect the following: Demographic data, cyst localization, serological test results, surgical findings and procedures, length of hospital stay, post-operative medical treatments and recurrence status. Based on this analysis, the female-to-male ratio was 27:14, with a mean age of 42.9±15.1 years (range, 19-75 years). Diagnosis was based on ultrasound, computed tomography or magnetic resonance imaging, and confirmed pre-operatively for 29 patients. Isolated kidney involvement was the most common finding (31.7%), whereas 12 patients had cysts in multiple locations. Isolated extrahepatic cysts were present in 30 patients (73.2%) and 11 (26.8%) had concurrent hepatic cysts. Surgery was performed on 34 patients for extrahepatic cysts alone, and on 7 (17%) for both hepatic and extrahepatic cysts; recurrence occurred in 4 patients (9.7%). Hepatic involvement (P=0.003), multiple cysts (P=0.033), multi-site involvement (P=0.033), history of surgery (P=0.002), concurrent liver surgery (P=0.019) and positive serology (P=0.030) were identified as risk factors for recurrence. The present results show that although imaging remains the cornerstone of extrahepatic cyst diagnosis, the disease was confirmed by radiology in only one-third of cases. Hydatid disease should be suspected in endemic regions; and surgery remains the most effective and commonly used treatment.