Surgical approaches to hepatic hydatidosis ranging from partial cystectomy to liver transplantation

Backgrounds/aims: A wide range of surgical approaches has been described for hepatic hydatidosis aiming primarily at the reduction of disease recurrence and minimization of postoperative morbidity.

Methods: A database analysis of patients with liver hydatidosis who underwent different surgical procedures between March 2010 and May 2016 was performed.

Results: A total of 21 patients with cystic echinococcosis (CE) and four cases of alveolar echinococcosis (AED) were detected. Nine patients manifested recurrent disease at presentation. Among CE cases, 5 underwent partial cystectomy (2 laparoscopic and 3 open), 9 cysto-pericystectomy (7 open and 2 robotic) and 7 hepatectomies (1 central, 4 right, 1 left and 1 right trisectionectomy). Living donor liver transplantation was performed in 3 patients with AED and the fourth patient underwent right trisectionectomy with en bloc resection of hepatic flexure and right diaphragm. Seven developed Clavien grade II and three grade III complications. The mean follow-up of CE was 34.19±19.75 months. One patient of laparoscopic partial cystectomy developed disease recurrence at 14 months. No recurrence was detected at a mean follow-up of 34±4.58 months following LDLT and at 24 months following multivisceral resection for AED.

Conclusions: The whole spectrum of tailored surgical approaches ranging from minimally invasive to open and extended liver resections represents safe, effective and recurrence-free treatment of hepatic hydatidosis.