Hepatic hydatid disease: current surgical treatment.

In the 11 years 1980 through 1990, we performed a total of 273 operations for hydatid disease of the liver in 252 patients, including 35 patients who were over the age of 75 years. Cysts were multiple in 24.6%, calcified in 17.9%, and ruptured to adjacent viscera in 12.3% of cases. Ruptured cysts were small as well as large. Coexisting gallstone disease was found in 14.3% of cases. Reoperations for recurrence were performed in 6.4% of cases. We believe that once the diagnosis is made, the treatment should be surgical, without regard to cyst size, the age of the patient, or the presence or absence of symptoms. Total pericystectomy, which eradicates the parasitic disease and thus minimizes the risk of recurrence, is the procedure of choice (17.3% in this series). When total pericystectomy is not feasible and the cysts are large and deeply placed, subtotal pericystectomy, in which only a small piece of the cystic wall is preserved, is a successful alternative (12.5% in this series). For complicated cysts, external drainage of the cystic cavity is necessary despite the known morbidity this procedure entails. In patients in this series undergoing external drainage, infection of the residual cavity and postoperative biliary fistula were the main causes of morbidity.