Surgical treatment of hydatid disease of the liver

Hydatid disease in southern Ontario is becoming more frequent because of infection in the large immigrant population. Review of 25 cases of hydatid disease of the liver has clarified the clinical features, diagnostic approach and methods of treatment. The commonest presenting symptoms were pain, mass or hepatomegaly, and jaundice. Diagnosis was confirmed, and cysts were localized, by Casoni skin testing, hepatic scanning and angiography. Surgical treatment consisted either of resection, excision or enucleation, and evacuation of the cyst. Two patients were treated by left lateral segmental resection, 6 by either wedge excision of the cyst or enucleation, and 14 by evacuation of cyst contents with or without drainage with the aid of a technique designed to prevent spillage of cyst contents at operation. None of the 14 treated by means of this technique developed recurrent disease, but in 4 of the patients treated by wedge excision or enucleation the cyst contents spilled at operation, resulting in recurrent disease in 2. Controlled cyst evacuation, with tube drainage for infected cavities and those communicating with the biliary tract is the recommended form of treatment in the management of hepatic hydatid disease.