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The optimal treatment of hydatid cyst of the liver: radical surgery with a significant reduced risk of recurrence.

BACKGROUND/AIMS
The management of hydatid cyst of the liver, which is still endemic in Turkey, varies from medical treatment or percutaneous drainage to different surgical procedures. In this study, we aimed to compare the efficacy of radical surgical procedures and conservative interventions with respect to recurrence rates.


METHODS
Patients who underwent any type of surgical treatment between March 1994 and March 2007 due to liver cyst hydatid were retrospectively evaluated. Data collection included demographic variables, diagnostic methods, surgical procedures, and morbidity and mortality rates.


RESULTS
242/258 (93.8%) patients with liver hydatid cyst underwent surgery, and the characteristics of 221 (91.3%) (123 female, 98 male) of these patients matched the criteria of the study. The mean age of the patients was 51 years (18-82 years). The diagnostic methods primarily included abdominal ultrasonography and computed tomography with a rate of 61.8% and magnetic resonance imaging in 12% of the patients. The patients were divided into two groups with respect to the treatment modality: Group A (n=92) - radical surgical treatment and Group B (n=129) - conservative surgery. The overall rate of recurrence was 15.3%. In Group B, this rate was 24% (n=31), whereas only 3.2% of the patients (n=3) in Group A had recurrence in the follow-up (p<0.05). The morbidity rate of the patients who underwent radical surgical modalities was also significantly lower.


CONCLUSIONS
Although conservative surgical procedures are considered simpler and safer to perform, the rate of postoperative complications such as biliary fistula, residual cavity and recurrence, and cavity suppuration has been reported to be about 35%. On the other hand, radical surgery can be performed with low risk of recurrence (3.2%). We believe radical surgical procedures present a lower rate of recurrence and less morbidity, and thus should be the surgical treatment of choice for hepatic hydatid disease.