Intact germinal layer of liver hydatid cysts removed after administration of albendazole

Abstract

Background: Hydatid disease is a common health problem especially in Mediterranean and sheep-farming countries, caused by infection with the metacestode stage of the tapeworm Echinococcus. The liver is the most frequent primary site of Echinococcus granulosus infection in humans. Surgery remains the main treatment modality for cystic hepatic hydatid disease, with complete resection of the germinal layer being of major importance for recurrence. Perioperative administration of albendazole has been reported to improve surgical outcome but the results are controversial. We report here our observations on the usefulness of preoperative chemotherapy in surgical outcome in terms of morbidity and recurrence.

Methods: Five patients with complex liver hydatid cysts received 28 days of albendazole prior to partial cystectomy. Radiological examinations with computed tomography and ultrasound and surgical outcome were used to assess the efficacy of the regimen.

Results: Three patients underwent a complete removal of the germinal layer of the cyst and there were no cases of biliary fistula in these patients. There were no relapses in any of the patients at 12 months' follow-up.

Conclusions: Preoperative use of medical therapy consisting of albendazole facilitates complete resection of the germinal layer by detaching it from the laminar layer, thus reducing not only the recurrence rates but also the postoperative complications, especially bilious fistulas.