Radical vs conservative surgery for hydatid liver cysts: experience from single center

Abstract

Aim: To compare the efficacy and safety of radical and conservative surgical interventions for liver hydatid disease.

Methods: The study comprised 59 patients in two groups who had undergone radical and conservative surgical procedures for liver hydatid disease in our department between 2004 and 2009. Preoperative diagnostic tools, medical treatments, demographic and clinical characteristics, postoperative follow-up, and recurrence were compared in both groups.

Results: This non-randomized retrospective study included 59 patients who had undergone liver hydatid disease surgery. The radical technique was used in 18 patients (mean age: 42.1 +/- 13.5 years, seven male, 11 female), and the conservative technique was used in 41 patients (mean age: 43.5 +/- 13.9 years, 17 male, 24 female). The follow-up period ranged from 3 to 58 mo. Although operative time was significantly shorter in the conservative group (P < 0.001), recurrence was significantly reduced in the radical group (P = 0.045). No statistically significant differences were found in terms of hospitalization duration, cyst count and size, location, postoperative complications, scolicidal solution usage, or follow-up duration between the two groups.

Conclusion: The more effective method for preventing postoperative recurrence is radical surgery. Endoscopic retrograde cholangiopancreatography for bile leakage in the early postoperative period may decrease the requirement for repeat surgery.

Figure 1

Multi-detector computed tomography (CT) images in different planes following contrast injection. A: Sagittal plane multi-detector CT images showed cystic lesions in segments 6 and 7 of the right liver lobe; B: A cystic lesion with a calcified wall located in the subcapsular region in the right lobe posterior segment was seen in contrast-enhanced axial plane CT sections; C: Contrast-enhanced axial plane CT images showed widespread cysts with separate membranes in an enlarged liver.

Figure 2

Contrast-enhanced axial CT and endoscopic retrograde cholangiopancreatography (ERCP) images of three different patients. A: A cystic lesion located in segment 3 of the left lobe was seen in contrast-enhanced axial plane CT images; B: A cystic lesion in the right lobe posterior superior and left lobe medial segment was seen in oral and intravenous contrast-enhanced axial plane CT images; C: Leakage of contrast material into the cyst cavity was observed after placing a cannula and injecting radiopaque material into the biliary tract; D: The same patient after performing a sphincterotomy and inserting a 7 Fr biliary stent.