Adjuvant therapy in the treatment of complications following surgery for hepatic echinococcal cysts

Thirty-two patients had surgery for hepatic echinococcal cysts (HEC). Serio us complications were observed in 16 patients (50%): cyst recurrence (n = 4 ), infected residual cyst cavity (n = 7), infected residual cyst cavity wit h biliary and duodenal fistulae (n = 2), recurrent biliary obstruction foll owing open surgery for a ruptured HEC into the biliary tree (n = 2), delaye d rupture of an HEC into the biliary tree following laparoscopic surgery wi th secondary biliary obstruction (n = 1). These major complications wen suc cessfully managed by percutaneous methods in 8 of 16 patients while antihel mintic therapy was sufficient in two patients with a small recurrent cyst a nd ERCP was used in one patient to relieve biliary obstruction. Surgery was required in two patients only. With a success rate of 87.5%. the nonsurgic al approach is the preferred method for treating a post-surgical complicati on.