Comparing two different surgical approaches (Conservative and Radical) in combination with Albendazole for the treatment of hydatid cyst. A 30-year retrospective study from a large series of patients.

Kostas Tepelenis, Stefanos Stefanou, Christos Stefanou, George Pappas - Gogos, Nikolaos Zikos, Spyridon Spyrou, Spyridon Koulas



Background: Hydatid disease management varies from medical treatment or percutaneous drainage to different surgical procedures. The aim of this study is to evaluate different surgical approaches with a specific administration of Albendazole.

Methods: One hundred fifty four patients underwent conservative surgery (Group A, unroofing with marsupialization, capitonnage, omentoplasty or external drainage) and seventy five patients radical surgery (Group B, pericystectomy or hepatectomy). Albendazole was given 5 days preoperatively in both groups and continued for 1 month postoperatively only in patients of Group A with viable protoscolices at the time of operation.

Results: No deaths occurred intraoperatively or during the first 30 postoperative days in both Groups. The mean hospital stay in Group A was 10.8 days (range 7-43) while in Group B was 11.7 days (range 7-46). Only one patient in Group A (0.6%) having viable protoscolices at the time of operation developed relapse of the disease after 52 months of follow-up. The complication rate in Group A was 23.3 % whereas in Group B was 30.6%. No statistical differences were observed in terms of hospitalization, complication and relapse rate (p=0.43, 0.83 and 0.48 respectively). The only independent variable that could affect the treatment is the diameter of the cysts (B=0.442, P<0.001).  

Conclusions: Conservative and radical surgery have almost zero recurrence when they are combined with a specific administration of Albendazole. Furthermore we deemed that unroofing procedure with the administration of Albendazole five days prior and one month postoperatively only in the presence of viable protoscolices should be the first line procedure for most of Hydatid liver disease as the procedure is simpler, easier to perform and requires no advanced surgical skills or a certain degree of experience.



Keywords: liver hydatid cyst, surgical treatment, postoperative recurrence, complication rate, comparison of radical and conservative approaches.

Full Text:



Romig T, Ebi D, Wassermann M. Taxonomy and molecular epidemiology of Echinococcus Granulosus. Vet Parasitol2015;213:76-84.

Wang N, Zhong X, Song X, et al. Molecular and biochemical characterization of calmodulin from Echinococcus Granulosus. Parasit Vectors2017;10:597.

Yang Y.R, Sun T, Li Z et al. Community surveys and riskfactor analysis of human alveolar and cystic echinococcosis in Ningxia Hui Autonomous Region, China. Bull World Health Organ 2006;84:714–721.

McManus DP, Zhang W, Li J, Bartley BP. Echinococcosis. Lancet 2003;362:1295-1304.

Kammerer WS, Schantz PM. Echinococcal disease. Infect Dis Clin1993;7:605-618.

Carrimm ZI, Murchison JT. The prevalence of simple renal and hepatic cysts detected by spiral computed tomography. Clin. Radiol2003;58:626–629.

Karaman U, Miman O, Kara M, Gicik Y, Aycan OM, Atambay M. Hydatid cyst prevalence in the region of Kars. ParazitolojiDerg2005;29:238-240.

Rossi P, Tamarozzi F, Galati F et al. The first meeting of the European Register of Cystic Echinococcosis (ERCE). Parasites & Vectors 2016;9:243.

Wang K, Zhang X, Jin Z, Ma H, Teng Z, Wang L. Modelling and analysis of the transmission of echinococcosis with application to Xinjiang Uygur Autonomous Region of China. J TheorBiol2013;333:78-90.

Koulas SG, Sakellariou A, Betzios J et al. A 15-year experience (1988-2003) in the management of liver hydatidosis in Northwestern Greece. IntSurg2006;91:112-116.

Menezes da Silva A. Hydatid cyst of the liver-criteria for the selection of appropriate treatment. Acta Trop 2003;85:237-242.

Brunetti E, Kern P, Vuitton DA. Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010;114:1-16.

Gomez I, Gavara C, Lopez-Andujar R et al. Review of the treatment of liver hydatid cysts. World J Gastroenterol2015;21:124-131.

Prousalidis J, Kosmidis CH, Fahantidis E, Harlaftis N, Aletras O. Surgical treatment of multiple cystic echinococcosis. HPB 2004;6:110-114.

Tsimoyiannis EC, Siakas P, Glantzounis G, Tsimoyiannis JC, Karayianni M, Gossios KJ. Intracystic pressure and viability in hydatid disease of the liver. IntSurg 2000;85:234-236.

Bhutani N, Kajal P. Hepatic echinococcosis: A review. Ann Med Surg2018;36:99-105.

Goja S, Saha SK, Yadav SK, Tiwari A, Soin AS. Surgical approaches to hepatic hydatidosis ranging from partial cystectomy to liver transplantation. Ann Hepatobiliary Surg 2018;22:208-215.

Patkowski W, Krasnodebski M, Grat M, Masior L, Krawczyk M. Surgical treatment of hepatic Echinococcus Granulosus. Prz Gastroenterol 2017;12:199-202.

Aydin U, Yazici P, Onen Z et al. The optimal treatment of hydatid cyst of the liver: Radical surgery with a significant risk of recurrence. Turk J Gastroenterol 2008;19:33-39.

Tagliacozzo S, Miccini M, Bonapasta SA, Gregori M, Tocchi M. Surgical treatment of hydatid disease of the liver: 25 years of experience. Am J Surg 2011;201:797-804.

Yorganci K, Sayek I. Surgical treatment of hydatid cysts of the liver in the era of percutaneous treatment. Am J Surg 2002;184:63-69.

Magistrelli P, Masetti R, Coppola R, MessiaA,Nuzzo G, Picciocchi A. Surgical treatment of hydatid disease of the liver. A 20-year experience. Arch Surg 1991;126:518-522.

Georgiou GK, Lianos GD, LazarosA et al. Surgical management of hydatid liver disease. Int J Surg 2015;20:118-122.

Safioleas MC, Misiakos EP, Kouvaraki M, Stamatakos MK, Manti CP, Felekouras ES. Hydatid disease of the liver. A continuing surgical problem. Arch Surg 2006;141:1101-1108.

Yuksel O, Akyurek N, Sahin T, Salman B, Azili C, Bostanci H. Efficacy of radical surgery in preventing early local recurrence and cavity-related complications in hydatic liver disease. J Gastrointest Surg 2008;12:483-489.

Akbulut S, Senol A, Sezgin A, Cakabay B, Dursun M, Satici O. Radical vs conservative surgery for hydatid liver cysts: Experience from single center. World J Gastroenterol 2010;16:953-959.

Martel G, Ismail S, Vandenbroucke-Menu F, Lapointe R. Surgical management of symptomatic hydatid liver disease: experience from a Western centre. Can J Surg 2014;57:320-326.

Marom G, Khoury T, Gazla SA et al. Operative treatment of hepatic hydatid cysts: A single center experience. Asian J Surg 2018. doi: 10.1016/j.asjsur.2018.09.013. [Epub ahead of print].

El-Malki HO, El-Mejdoubi Y, Souadka A et al. Does primary surgical management of liver hydatid cyst influence recurrence? J Gastrointest Surg 2010;14:1121-1127.

Avgerinos ED, Pavlakis E, Stathoulopoulos A, Manoukas E, Skarpas G, Tsatsoulis P. Clinical presentations and surgical management of liver hydatidosis: our 20 year experience. HPB 2006;8:189-193.

Mueller L, Broering DC, Vashist Y, Fischer L, Hiller C, Rogiers X. A retrospective study comparing the different surgical procedures for the treatment of hydatid disease of the liver. Dig Surg 2003;20:279-284.

Tsimoyiannis EC, Siakas P, Karayianni M, Kontoyiannis DS, Gossios KJ. Perioperative benzimidazole therapy in human hydatid liver disease. Int Surg 1995;80:131-133.



  • There are currently no refbacks.
Copyright 2016. All rights reserved.