Last update:
08-Mar-2007

Cystic hepatic hydatidosis, caused by the tape-worm Echinococcus granulosus, is an ancient disease, endemic in sheep rearing areas. Despite improvement in conservative treatment, it remains a surgically treated disease for the good risk patient. It may present complicated and challenging problems in liver surgery and there continues to be controversy regarding the appropriate surgical technique. A series is presented of 200 patients, suffering from cystic hepatic hydatidosis, operated on consecutively from 1985 to 2001, applying the same operative procedures consisting of wide capsectomy and drainage. This surgical technique is described in detail. There was a mortality rate of 0.5% and postoperative complications occurred in 14%, mostly related to bile leaks. Endoscopy was selectively performed for biliary fistulas, taking into account the volume and duration of biliary drainage. They all healed and no re-operation was required. There was recurrence of echinococcus in 11 of the 115 patients monitored for from 4 to 20 years (i.e. 10%). Drainage operations, when properly performed, present excellent results regarding total extirpation of hepatic hydatidosis. Few postoperative complications and a low rate of late recurrences are observed, and the need for more aggressive surgical approaches is, in this way, reduced. Endoscopy may be successfully applied for treating long-lasting biliary fistulas following surgery.

Key words: Bile fistulas, Drainage operations, Endoscopy, Hepatic hydatidosis.