Hydatid disease in New Zealand. What remains and how should we treat it?

Aim. The incidence of hydatid disease in New Zealand has steadily declined since the introduction of control measures in the early 1960s. However, pat ients continue to present for management of newly recognised, disseminated or recurrent disease. It is desirable that doctors in New Zealand have some knowledge of current patterns of presentation and management of the diseas e. Methods. Twenty-five patients with hydatid disease have been seen and manag ed over a ten-year period by one hepato-biliary surgeon. Their presentation and management is outlined and discussed. Surgery, after pretreatment with albendazole, was undertaken in 15 patients where eradication seemed possib le and desirable and in three others presenting with complications (infecti on, rupture, fistulation). Albendazole treatment alone was used in six pati ents (five with uncomplicated recurrent or disseminated disease) and one pa tient has simply been observed. Results. There were no deaths in 18 patients who underwent surgery and no r ecurrent disease has been found. Major morbidity was confined to those havi ng surgery for complications. All six patients who received albenzadole alo ne had a good clinical and radiological response, though they required foll ow-up. Conclusions. It is suggested that surgery (with albendazole pre-treatment) should be reserved for those with either curable disease or complications a nd that all others should be managed, in the first instance, by albendazole alone. Providing treatment is instituted before complications develop it s hould be associated with minimal morbidity.