DIAGNOSTIC EVALUATION AND SURGICAL-MANAGEMENT OF HYDATID-DISEASE OF THE LIVER

Human echinococcosis is still endemic in some areas of the world, incl uding Mediterranean countries. Because there is no effective medical t herapy, surgery remains the principal mode of treatment. A consecutive series of 132 patients operated on for liver hydatid disease between January 1977 and February 1993 were analyzed. There were 60 men (45.4% ) and 72 women (54.6%) aged 31 to 88 years (mean 56 years). The right lobe of the liver was affected in 68 cases (51.5%), the left lobe in 3 1 cases (23.5%), and both lobes in 14 cases (10.6%); there were multip le liver cysts in 7 cases (5.3%), concomitant cysts in other parenchym al organs in 4 cases (3.0%), and disseminated intraabdominal hydatid d isease in 8 cases (6.1%). Clinical symptomatology consisted of abdomin al pain, fever, jaundice, urticaria, and an abdominal mass. Preoperati ve diagnosis was established using imaging studies: plain abdominal fi lms, ultrasonography, computed tomography, and serologic tests. Three patients (2.3%) underwent simple closure without drainage, 7 patients (5.3%) cyst excision, 4 patients (3.0%) marsupialization, 1 patient (0 .8%) left lateral segmentectomy, 15 patients (11.3%) external drainage , 69 patients (52.3%) omentoplasty, and 33 patients (25.0%) combinatio ns of procedures. Postoperative morbidity was low and consisted of hep atic abscess development, wound infection, bowel obstruction, and bili ary leaks. Six patients (4.5%) had recurrent disease. One patient died during the postoperative period because of septic complications. Amon g the surgical techniques we used, excision of the cyst (when feasible ) and omentoplasty produced the lowest complication rates and the best clinical results.