[Surgical treatment of central echinococcal cysts of the liver]

While in the treatment of the peripheral Hydatic Cyst of the liver the complete extirpation of the cyst is today recognized as a curing method, at the Central Type of Hepatic Cyst, there are often suggested and performed surgical treatments which in today's phase could be appraised as incorrect. The Central Hepatic Cyst ought to be entirely removed (cyst and pericyst). All vascular and biliary elements, which go from the liver parenchym to the pericyst, must be exactly tied up. The remaining cavity at liver, is always primarily closed with the parenhymatic liver suture. In the case that there exists a wider communication with larger intrahepatic bile ducts or if there is already present the previously existing intermittent icterus, it is necessary to perform a choledochotomy, in order to prevent the appears of the biliary fistulas. The common bile duct ought to be explored, papilla of Vater dilated up to 20 to 22 Ch, the operative Cholangiography performed and an adequately thick T tube placed.