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Open surgical management of pediatric hepatic hydatid cysts: a retrospective cohort study
Amin Sabourifard1, Ahmad Mohammadipoor2, Mostafa Abrishami2
1Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Background:
Cystic echinococcosis (CE), caused by Echinococcus granulosus, remains a major public health concern in endemic regions such as Iran. The liver is the most affected organ in children, and surgical intervention is often required due to the risk of complications and recurrence.
Objective:
To evaluate the outcomes of open surgical treatment for hepatic hydatid cysts in pediatric patients managed at two tertiary pediatric hospitals.
Methods:
A retrospective cohort analysis was conducted on 102 children who underwent open surgery between 2017 and 2024. Data were retrospectively collected from medical records and included demographic characteristics, cyst features, surgical techniques, liver function tests, vital signs, and postoperative outcomes. Surgical procedures included intracystic drainage, partial cystectomy, and simple cystectomy. Statistical analysis was performed using SPSS version 24.
Results:
Among the 102 pediatric patients, 62.7% were male, with a mean age of 9.08 years. The right hepatic lobe was affected in 66.7% of cases. Surgical interventions included intracystic drainage (49.0%), partial cystectomy (31.4%), and simple cystectomy (19.6%). The most frequent postoperative complications were bile leakage (6.9%) and anaphylaxis (4.9%). Recurrence occurred in 2.9%of patients, all of whom had undergone intracystic drainage. Crucially, the single reported mortality case was also associated with intracystic drainage rather than partial cystectomy. Younger children and female patients had significantly shorter hospital stays, although baseline cyst sizes were larger in females.
Conclusion:
Open surgery remains a safe and effective treatment for hepatic hydatid cysts in children, demonstrating a high recovery rate (99.0%) and low recurrence. However, intracystic drainage was associated with increased rates of bile leakage, recurrence, and mortality. Age and gender influenced hospital stay duration but not complication rates. Larger prospective studies are warranted to refine surgical strategies and improve long-term outcomes.
