Surgical treatment of human echinococcosis

Hydatid disease may affect several organs in the human body and thus repres ents a major challenge for the general surgeon. The aim of this study was t o analyze the multiple clinical presentations of hydatid disease and the su rgical options according to the involved organ. The medical records of 272 adult patients operated on for hydatid disease in our department during the period 1970-1996 were retrospectively reviewed. The most commonly involved organ was the liver (204 patients; 75%), followed by the lung (42 patients ; 15.4%) and the spleen (14 patients; 5.1%). In 12 patients, the cysts were located in uncommon sites: in the pancreas (4 patients; 1.5%), the gallbla dder (2 patients; 0.74%), the kidney, the thyroid gland, the breast, the pe ricardium, the supraclavicular region and the thigh (1 patient in each case ; 0.37%). Clinical symptomatology varied according to anatomic location and pre-operative diagnosis was accomplished with plain abdominal films, ultra sound, computerized tomography and serological tests. The surgical procedur es performed included simple closure with drainage, unroofing of the cyst w ith omentoplasty (for liver cysts), marsupialization, cyst excision, excisi on of the involved organ or combinations of procedures. Postoperative morbi dity was mainly due to septic complications (n = 41), postoperative bleedin g (n = 2), deep vein thrombosis (n = 2) and fistulae (n = 13). Four patient s died in the early postoperative period (mortality rate, 1.5%) secondary t o septic complications (n = 3) and pulmonary embolism (it = 1). During long -term follow-tip, 14 patients developed recurrent disease. In conclusion, h ydatid disease should be included in the differential diagnosis of cystic m asses in solid organs or other anatomic sites, especially in endemic countr ies. Since there is not an effective medical treatment, surgery still remai ns the treatment of choice, offering a good clinical result and an acceptab le recurrence rate.