The use of conservative or radical
surgical procedures in the management of
hepatic echinococcosis is controversial. A review of data on 23 patients with
hydatid cysts of the liver that were diagnosed between 1935 and 1990 at our institution was undertaken to determine the safety and efficacy of various
surgical procedures. In eight patients (group 1), the
cysts were treated conservatively by instillation of a scolicidal agent followed by evacuation of the
cyst, drainage, or omentoplasty of the residual
cyst cavity. Thirteen patients (group 2) underwent radical excision of the
cyst by either pericystectomy or hepatic resection. In addition, two patients were treated by combined techniques.
Scolicidal agents were used in 18 patients (78%) and apparently resulted in
caustic biliary injury and death in 2 patients. Group 1 and group 2 patients had similar complication rates (62% and 54%, respectively) and mean
hospital stay (24 and 23 days, respectively). Recurrent
cysts, however, were detected in three of six patients who underwent a conservative
surgical procedure and participated in follow-up, whereas no patients treated by a radical procedure had a recurrence. Because pericystectomy and hepatic resection resulted in a low rate of recurrence and eliminated the need for use of potentially toxic
scolicidal agents, these procedures may be the preferred method for the surgical management of hepatic
hydatid disease.