Liver hydatid cyst: pattern and methods of surgical treatment

ABSTRACT

Hydatidosis of liver is very old surgical problem worldwide and one of the commonest parasitic diseases that affect the man's health. In humans, 50% to 75% of hydatid cysts occur in the liver. The radical surgical removal of the cystic lesion remains the mainstay of treatment with a high success rate. The aim of this paper to report the surgical management of liver hydatid diseases in Iraq. 34 patients [59% males, 41% females] were observed during the period from April 2008 to May 2010, the mean age is 42 years. All patients were examined clinically and diagnosis obtained radiologically [ultrasonography, CT scan and in selected cases MRI], operative and postoperative details were recorded for every patient. The mean age of the patients was 42 years [range, 16-62 years]. 20 patients [59%] were males and 14 patients [41%] were females. The peak age group affected was between 3[rd] - 6[th] decades in 70.5%. The disease was primary in 23 patients [68%] and recurrent in patients [32%]. The cyst was single in 14 patients [41%] and multiple in 20 patients [59%]. Fifty percent multiple hydatid disease was recurrent, while the other 50% was primary. The Rt. Lobe of the liver was affected in 19 cases [56%], the Lt. lobe was affected in 4 patients [12%], and both lobes were involved in 11 patients [32%]. The clinical presentation include upper abdominal pain/ discomfort in 18 patients [53%], palpable mass in 5 patients [14.7%], jaundice in 3 patients [8%], acute abdomen in 2 patients [6%], incidental findings in 6 patients [17.5%]. Mode of surgical treatment was as follow excision and external tube drainage in 14 patients [41%], excision and partial pericystectomy [resection of redundant cyst wall and the residual cavity left open] in 7 patients [20.5%], excision and omentoplasty in 6 patients [17.5%], excision and primary suturing of the cyst wall and filling the cavity with normal saline in 5 patients [15%], and excision and marsupialization in 2 patients [6%]. No significant statistical difference in terms of morbidity and mortality between different surgical procedures, however cystectomy with external drainage was considered the standard surgical procedures especially in large sized cysts and bile communicate done