Radical surgical therapy of abdominal cystic hydatid disease: Factors of recurrence

A series of 74 consecutive patients (48 women, 26 men) were operated for ab dominal hydatid disease between June 1949 and December 1995. The patients r anged in age from 15 to 81 years (median 49 years). In 69 cases only the li ver was affected; two patients had concomitant extrahepatic disease (one sp leen, one spleen and lung), and 3 had cysts in the spleen only. Cysts were multiple in 11 patients and calcified in 24. Conservative surgical procedur es were used for 22 cysts in 20 patients [open partial (n = 3), open total (n = 6), closed total cystectomy (n = 9), marsupialization (n = 2), drainag e (n = 2)] and radical surgical procedures for 72 cysts in 53 patients [per icystectomy (n = 41), wedge liver resection or hemihepatectomy (n = 25), sp lenectomy (n = 5), radical resection of a lung cyst (n = 1)]. Altogether 37 patients (50%) were given perioperative antihelmintic chemotherapy with me bendazole (18 patients) or albendazole (19 patients). Operative mortality r ates were 5.0% after conservative surgery and 1.8% after radical surgery. M orbidity rates were 25.0% following conservative surgery and 24.1% followin g radical surgery, Antihelmintic therapy was well tolerated by all but five patients. All side effects were entirely reversible. Among the 74 patients , 60 (81.0%) were available for long-term follow-up (median 7.2 years; rang e 2.0-47.0 years). Recurrence of disease was seen in 9 of 60 patients at an interval of 3 months to 20 years from the first operation. The rate of rec urrence was significantly lower after radical surgical procedures (p = 0.03 ) and after closed removal of the cyst (p = 0.04).