Diagnosis and Surgical Approach in 76 Cases of Hepatic Hydatid Cysts in Adults and Children - Abstract
Background: The high prevalence of hepatic hydatid cyst (HHC) still remains one of the major public health problems in our country.
Patients and Method: In the last 30 years, 76 patients with HHC have been operated on in our department. Their clinical and pathological features, diagnosis, surgical treatment and outcome are retrospectively analyzed.
Results: The study group comprised 47 (61.8%) males and and 29 (38,1%) females. The age of the patients varies between 8-72 (range 44) years. Pediatric cases presented clinical and therapeutical pecularities. Diagnosis was established by physical examination, serology, ultrasono-graphy and rarely CT scan. Fifty-five cysts were located in the right lobe, 15 cysts in the left lobe and 6 cysts were bilateral. Twelve patients had multiple cysts and 3 patients had co-existing cysts with different abdominal or lung locations. There were 6 cases with recurrent disease. Majority of our cases had complications i.e. infection (n=15), rupture in the biliary duct without or with obstructive jaundice (n=13), rupture in the peritoneal cavity with acute abdomen (n=2), another co-morbidity (n=5). All patients underwent surgical treatment but in 6 cases the laparoscopic approach has been successfully used. Surgical procedures were partial cyst pericystectomies with external (n=60) or internal (n=2) drainage in 62 cases, total cyst pericystectomies in 7 cases, and left hepatic (atypical or segmentary) resections in 7 cases. The common bile duct was explored in 11 patients and it was drained by a T-tube in 6 cases or by choledocoduodenostomy in three
others. Papilosphincterotomy was practiced in two patients. Chemotherapy (albendazole) was sporadically used after surgery. We had no deaths but a significant rate of morbidity (n=15; 19,7%) with a prolonged hospital stay.
Conclusion: Surgery remains the mainstay treatment of HHC. The topography and volume together with the great number of complicated cases and co-existing pathology forced us to a variety of surgical approaches most of them conservative. Our results were encouraging with acceptable morbidity and no lethal cases for the study period.