Conservative versus radical surgery for treatment of uncomplicated hepatic hydatid cysts

Abstract

This work evaluated both radical and conservative surgical approaches in the management of hepatic hydatid cyst. A total of 32 cases with uncomplicated hepatic hydatid cysts were divided into 2 groups according to the type of surgery. Patients in the first group (n=18) were subjected to conservative surgery in the form of endocystectomy, omentoplasty with or without drainage. Cases in the second group (n=14) underwent radical surgery that included closed pericystectomy, open pericystectomy, wedge hepatic resection or segmentectomy. The results showed that the use of rib cage retractor could avoid the need for thoracotomy incision with its morbidity to manage cysts at the dome of the liver. The mean operating time in GI (140.15 +/- 38.30 min) was significantly shorter than in GII (190.4 +/- 50.2 min), with P< 0.05. The need of blood transfusion in GI (16.7%) was lesser than in GII (35.7%), but the difference was statistically not significant. The postoperative pain, evaluated by the number of IM analgesic injection was significantly lower in GI (7.2 +/- 3.3) than in GII (9.9 +/- 3.9) with P < 0.05. Wound complications were more observed in GII. There was only one reported recurrence in GI in a case with multiorgan cysts that did not receive perioperative anthelmintic chemotherapy. So, conservative surgical management of uncomplicated hepatic hydatid cysts with perioperative anthelmintic chemotherapy supposed to be a simple, safe and effective approach. Its efficacy is comparable to radical surgical procedures with much less morbidity.