Hydatid disease of the liver: A 12 year experience of surgical management

Abstract

Objective: Information about hydatid cyst disease in Ethiopia is scarce. This study was aimed at reviewing the clinical presentations, modes of surgical management and post-operative course of patients with hepatic hydatidosis in Tikur Anbessa hospital,

Methods: This was a retrospective study of 137 patients seen with hepatic hydatidosis at Tikur Anbessa Hospital, Department of Surgery, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia.

Results: The male: female ratio was 1.2:1. Patients’ age ranged from 13 to 67 years with a mean of 33.5 years. The majority (65%) of the patients came from the rural Ethiopia and 40% of the patients had been in frequent contact with domestic animals such as dogs. Abdominal pain and abdominal mass were the commonest symptoms. A palpable mass or hepatomegaly was found in 89.8% of cases, Ultrasonography and computed tomography were the main diagnostic procedures. The cysts were located in the right lobe of the liver in 76 patients (55.5%) and in the left lobe in 38(27.7 %); the other 23 patients (16.8%) had bilobar involvement. Most patients (78.1%) had a solitary cyst. Twenty-three patients had hydatid cystic lesions in other organs in addition to hepatic hydatidosis. The surgical approach was abdominal in 122(89.1%) patients, one- stage thoracoabdominal in 8(5.8%), and laparotomy and thoracotomy at interval in 7(5.1%) patients. Operative management consisted of conservative procedure in 126(92%) patients, namely evacuation in 93(67.9%), cystotomy in 21(15.3%), enucleation of intact cyst in 12(8.8%) patients. Radical procedure was done in 11(8%) patients, wedge resection in 10(5.8) patients, and lobectomy in only 1(0.7%) patient Twenty-seven (19.7%) patients developed Postoperative complication.

Conclusion: Complete excision of hydatid cyst(s) and procedures that conserve liver tissue are appropriate for most patients with hepatic hydatid cysts.