Radical surgery in hepatic hydatidosis: analysis of results in an endemic area

Liver and lung hydatid cysts with transdiaphragmatic rupture treated by radical surgery

Hydatidosis is a parasitic disease caused by Echinococcus granulosus, a tapeworm that is endemic in certain parts of the world. We present a case of hepatopulmonary hydatidosis with diaphragm involvement and close contact with the suprahepatic inferior vena cava treated with radical surgery. We discuss therapeutical surgical options (approach and type of surgery).

Radical surgery for liver hydatidosis

We have carefully read the article by Ramia et al. titled "Radical surgery in hepatic hydatidosis: an analysis of results in an endemic area", where the authors prioritize ultrasonographic assessment according to the World Health Organization (WHO) classification as a strategy for the surgical planning of hepatic hydatid cyst (HHC). However, they did not consider drug therapy or the use of contrast-enhanced computed tomography (CECT) during preoperative assessment, despite them being considered surgical success factors in the literature.

A review of the diagnosis and management of liver hydatid cyst

Hydatidosis is a zoonosis caused by Echinococcus in the larval stage. Humans are accidental intermediary hosts where cystic lesions develop, primarily in the liver and lungs. It is usually asymptomatic, hence it is usually incidentally identified. Symptoms result from cyst expansion and/or host inflammatory reaction. Hepatomegaly is the most common sign. Hydatidosis induces no specific changes in lab tests, but immunodiagnostics are available that may complement its study, with antibody detection being the method of choice. While ultrasound is the main diagnostic technique, tomography offers more accurate information regarding characteristics and anatomical relations. A number of therapy options are presently available. Treatment with albendazole, whether combined or not with praziquantel, is useful for smaller, uncomplicated cysts (< 5 cm). Only 30 % of cysts disappear with medical treatment alone. Surgery is indicated for bigger liver cysts (> 10 cm), at risk for rupture and/or complicated; the laparoscopic approach is scarcely widespread. The radical technique (total cystopericystectomy) is preferable because o its lower risk for postoperative abdominal infection, biliary fistula, and overall morbidity. Conservative techniques are appropriate in endemic areas where surgery is performed by nonspecialist surgeons. PAIR (puncture-aspiration-injection-reaspiration) is an innovative technique representing an alternative to surgery. It is indicated for inoperable cases and/or patients who reject surgery, for recurrence after surgery, and for lack of response to medical treatment. Active surveillance without treatment may be indicated for quiescent or inactive, uncomplicated liver cysts.