Hydatid Cyst of the Liver

HYDATID CYST OF THE LIVER

Surgery in Parasitic Liver Diseases

Our country is an endemic region for hydatid cyst disease.

Hydatid Cyst

A medical disease?

A surgical disease?
 

Treatment                 

The aim of treatment is to eliminate the disease together with its complications, to remove the local disease, and to reduce recurrence by keeping mortality and morbidity rates to a minimum
 

Medical treatment

Albendazole

10 mg/kg per day in two equal doses, in 3 courses of 28 days

Percutaneous treatment

For unilocular cysts
 

PAIR technique (puncture, aspiration, injection, re-aspiration)

Indications for surgery:

The characteristics of the patient and of the cyst are important.

For uncomplicated, large, peripherally located viable cysts there is a consensus in favor of surgery. Small (<4cm), deep parenchymal cysts

Calcified cysts in patients over 60 years of age: conservative treatment. Treatment:

covers a wide spectrum, from marsupialization to liver resection.

What guides the treatment is the staging system.

Gharbi et al. ultrasound staging system

A Common Language

Instead of debating which method is superior in the treatment of hydatid cyst of the liver, it will be more useful to discuss which treatment method should be chosen for which type of hydatid cyst.

Conservative Treatment:

Removing the cyst contents from the abdomen without spillage into the peritoneum

Eliminating the cavity left in the liver after the cyst

 

Treatment Protocols:

Conservative-Radical Surgery

Percutaneous Drainage-Surgery

Laparoscopic – Conventional Surgery
 

SURGERY

Choice of Radical Surgery:

The rate of cyst recurrence is markedly lower than with conservative procedures.

Cystectomy / Segmental or Lobar Hepatectomy

Cystotomy + omentopexy

Cystotomy + leaving the cavity open to the peritoneal cavity

Cystotomy + marsupialization

Cystotomy + external drainage via a tube

Cystotomy + filling with saline + closure

For prevention, 1 week of preoperative albendazole treatment is given (10 mg/kg/day, 2 x 1).

In patients with a ruptured cyst or spread of the cyst contents, oral treatment is continued for 1 month.
 

Determining factors:

Stage of the cyst

Number of cysts

Size of the cyst

Location of the cyst in the liver

Recurrent hydatid cyst of the liver
 

Complications:

Secondary infections of the cyst cavity

Biliary fistulas

Biliary infection – sepsis

Obstructive jaundice

Pancreatitis

Choledochotomy – T-tube drainage

ERCP

Treatment

Treatment of bile duct communications

>10 cm cysts have a high incidence