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Development in diagnosis and treatment of hepatic echinococcosis in a surgical department of a Mediterranean centre over a 20-years period.

Liver echinococcosis is an endemic disease in some areas of the world like Middle East and is a serious problem both from social-economic and clinical-therapeutical stand-points in other areas like Mediterranean regions. We report our experience on hepatic echinococcosis diagnosis and treatment over a 20-year period. In this retrospective study we have reviewed 89 patients affected by hepatic hydatidosis who underwent surgery in our Unit (between November 1975 and October 1995). Patients were divided into two groups: group A including 65 patients (30 males and 35 females) operated on between 1975 and 1988 and group B including 24 patients (11 males and 13 females) operated on between 1989 and 1995. Main outcome measures reported were recurrence of echinococcosis, association with surgical procedure, complications, diagnostic trial. In group A we performed 41 marsupializations, 20 subtotal pericystectomies and 4 total pericystectomies; while 14 total pericystectomies and 10 liver resections were performed in group B. Postoperative hospital stay was of 30 days for group A patients and of 18 days for group B. A single death occurred in group A. Recurrences occurred in group A only (11 cases equal to 17%) and were treated with total pericystectomies (8 cases) and liver resections (3 cases). Our study shows the development of diagnostic procedures trial during the 20-year period and the different surgical approaches between the two groups. Nevertheless we believe that surgical procedures should be tailored to each patient avoid H high surgical risk due to the benign nature of the disease.