Diagnostic evaluation and surgical management of hydatid disease of the liver

Human echinococcosis is still endemic in some areas of the world, including Mediterranean countries. Because there is no effective medical therapy, surgery remains the principal mode of treatment. A consecutive series of 132 patients operated on for liver hydatid disease between January 1977 and February 1993 were analyzed. There were 60 men (45.4%) and 72 women (54.6%) aged 31 to 88 years (mean 56 years). The right lobe of the liver was affected in 68 cases (51.5%), the left lobe in 31 cases (23.5%), and both lobes in 14 cases (10.6%); there were multiple liver cysts in 7 cases (5.3%), concomitant cysts in other parenchymal organs in 4 cases (3.0%), and disseminated intraabdominal hydatid disease in 8 cases (6.1%). Clinical symptomatology consisted of abdominal pain, fever, jaundice, urticaria, and an abdominal mass. Preoperative diagnosis was established using imaging studies: plain abdominal films, ultrasonography, computed tomography, and serologic tests. Three patients (2.3%) underwent simple closure without drainage, 7 patients (5.3%) cyst excision, 4 patients (3.0%) marsupialization, 1 patient (0.8%) left lateral segmentectomy, 15 patients (11.3%) external drainage, 69 patients (52.3%) omentoplasty, and 33 patients (25.0%) combinations of procedures. Postoperative morbidity was low and consisted of hepatic abscess development, wound infection, bowel obstruction, and biliary leaks. Six patients (4.5%) had recurrent disease. One patient died during the postoperative period because of septic complications. Among the surgical techniques we used, excision of the cyst (when feasible) and omentoplasty produced the lowest complication rates and the best clinical results. Résumé L'échinococose humaine sévit encore à l'état endémique dans certaines régions, y compris le bassin méditerranée. Etant donné qu'il n'existe pas de traitement médical efficace, la chirurgie reste la modalité thérapeutique principale. Une série consécutive de 132 patients opérés pour un kyste hydatique du foie entre Janvier 1977 et Février 1993 sont l'objet de cet article. Il y avait 60 hommes (45.5%) et 72 (54.6%) femmes, âgées entre 31 et 88 ans (âge moyen=56 ans). Le foie droit était intéressé dans 68 (51.5%) cas, le lobe gauche dans 31 (23.4%), les deux lobes dans 14 (10.6%) cas alors qu'il existait des kystes multiples dans 7 (5.3%) cas. Il y avait des kystes concomitants dans un autre parenchyme dans quatre cas (3%) et une dissémination intraabdominale dans 8 cas (6%). La symptom