World Journal of Surgery

, Volume 18, Issue 6, pp 859–865 | Cite as

Diagnostic evaluation and surgical management of hydatid disease of the liver

  • Michael Safioleas
  • Evangelos Misiakos
  • Christine Manti
  • Demetrios Katsikas
  • Gregory Skalkeas
Société International de Chirurgie-Manuscripts Presented at the 35th World Congress of the International Society of Surgery, Hong Kong, August 1993

Abstract

Human echinococcosis is still endemic in some areas of the world, including Mediterranean countries. Because there is no effective medical therapy, surgery remains the principal mode of treatment. A consecutive series of 132 patients operated on for liver hydatid disease between January 1977 and February 1993 were analyzed. There were 60 men (45.4%) and 72 women (54.6%) aged 31 to 88 years (mean 56 years). The right lobe of the liver was affected in 68 cases (51.5%), the left lobe in 31 cases (23.5%), and both lobes in 14 cases (10.6%); there were multiple liver cysts in 7 cases (5.3%), concomitant cysts in other parenchymal organs in 4 cases (3.0%), and disseminated intraabdominal hydatid disease in 8 cases (6.1%). Clinical symptomatology consisted of abdominal pain, fever, jaundice, urticaria, and an abdominal mass. Preoperative diagnosis was established using imaging studies: plain abdominal films, ultrasonography, computed tomography, and serologic tests. Three patients (2.3%) underwent simple closure without drainage, 7 patients (5.3%) cyst excision, 4 patients (3.0%) marsupialization, 1 patient (0.8%) left lateral segmentectomy, 15 patients (11.3%) external drainage, 69 patients (52.3%) omentoplasty, and 33 patients (25.0%) combinations of procedures. Postoperative morbidity was low and consisted of hepatic abscess development, wound infection, bowel obstruction, and biliary leaks. Six patients (4.5%) had recurrent disease. One patient died during the postoperative period because of septic complications. Among the surgical techniques we used, excision of the cyst (when feasible) and omentoplasty produced the lowest complication rates and the best clinical results.

Résumé

L'échinococose humaine sévit encore à l'état endémique dans certaines régions, y compris le bassin méditerranée. Etant donné qu'il n'existe pas de traitement médical efficace, la chirurgie reste la modalité thérapeutique principale. Une série consécutive de 132 patients opérés pour un kyste hydatique du foie entre Janvier 1977 et Février 1993 sont l'objet de cet article. Il y avait 60 hommes (45.5%) et 72 (54.6%) femmes, âgées entre 31 et 88 ans (âge moyen=56 ans). Le foie droit était intéressé dans 68 (51.5%) cas, le lobe gauche dans 31 (23.4%), les deux lobes dans 14 (10.6%) cas alors qu'il existait des kystes multiples dans 7 (5.3%) cas. Il y avait des kystes concomitants dans un autre parenchyme dans quatre cas (3%) et une dissémination intraabdominale dans 8 cas (6%). La symptomatologie clinique comprenait la douleur abdominale, la fièvre, l'ictère, l'urticaire et une masse abdominale dans les proportions variables. Le diagnostic préopératoire a été établi avec des études radiographiques simples, l'échographie, la tomodensitométrie et la sérologie spécifique. Trois patients (2.3%) ont eu une simple fermeture du kyste sans drainage, sept (5.3%) ont eu une excision de leur kyste, quatre (4%) ont eu une marsupialisation, un patient (0.7%) a eu une epiplooplastie et 33 (25%) ont eu une combinaison de ces procédés. La morbidité postopératorie était basse et a consisté en la formation d'un abcès hépatique, une infection de la plaie opératoire, une occlusion intestinale et une fuite biliaire. Six patients (4.5%) ont eu une récidive de leur maladie. Un patient est décédé pendant la périodo postopératoire de complications septiques. Entre les techniques utilisées, l'excision du kyste, lorsque réalisable, et épiplooplastie sont associées avec le taux de morbidité le plus bas et les meilleurs résultats cliniques.

Resumen

La equinococosis humana todavía es una enfermedad endémica en algunas áreas del mundo, inclusive en los países mediterráneos. Puesto que no existe un tratamiento médico efectivo, la cirugía sigue siendo la modalidad terapeútica principal. Una serie consecutiva de 132 pacientes operados por enfermedad hidatídica del hígado entre enero de 1977 y febrero de 1993 fue analizada: 60 hombres (45.4%) y 72 mujeres (54.6%) con edades entre 31 y 88 años (edad promedio 56 años). El lóbulo derecho del hígado apareció comprometido en 58 casos (51.5%), el lóbulo izquierdo en 31 casos (23.4%) y ambos lóbulos en 14 casos (10.6%); múltiples quistes registraron en 7 casos (5.3%), quistes concomitantes en otros órganos parenquimatosos en 4 casos (3%) y enfermedad hidatídica intraabdominal diseminada en 8 casos (6%). La sintomatología clínica consitió en dolor abdominal, fiebre, ictericia, urticaria y masa abdominal. El diagnóstico preoperatorio fue establecido por medio de imágenes: radiografía simple del abdomen, ultrasonido, tomografía axial computadorizada y pruebas serológicas. Tres pacientes (2.3%) recibieron sutura simple sin drenaje, 7 (5.3%) excisión del quiste, 4 (3%), marsupialización y 1 (0.7%) omentoplastia; 33 pacientes (25%) fueron sometidos a una combinación de procedimientos. La morbilidad postoperatoria fue baja y consistió en el desarrollo de abscesos hepáticos, infección de la herida, obstrucción intestinal y escapes biliares. Seis pacientes (4.5%) desarrollaron enfermedad recurrente. Un paciente murió en el período postoperatorio debido a complicaciones sépticas. Entre las técnicas quirúrgicas utilizadas, la excisión del quiste, cuando ésta es posible, y la omentoplastia exhiben las más bajas tasas de complicaciones y los mejores resultados clínicos.

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Copyright information

© Société Internationale de Chirurgie 1994

Authors and Affiliations

  • Michael Safioleas
    • 1
  • Evangelos Misiakos
    • 1
  • Christine Manti
    • 2
  • Demetrios Katsikas
    • 1
  • Gregory Skalkeas
    • 1
  1. 1.Second Department of Propedeutic SurgeryAthens University Medical School, Laiko General HospitalAthensGreece
  2. 2.Department of Microbiology, Aglaïa KyriakouChildren's Hospital of AthensAthensGreece

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