All patients with hydatid disease should be considered for percutaneous or surgical treatment because of the risk of life-threatening complications of untreated disease. More complicated cysts are better managed surgically. Treatment of hydatid cysts is associated with two technical problems: (1) risk of anaphylaxis from spillage of cyst fluid containing eggs and larvae into the peritoneal cavity and (2) recurrence caused by residual eggs in incompletely removed germinal membranes. [22]
To prevent these problems, most surgeons use a technique in which the cyst contents are aspirated and replaced with a hypertonic saline solution to kill residual daughter cysts in the germinal membrane before unroofing and pericystectomy. [23] The goal of the latter procedure is to excise the germinal membrane, leaving the inflammatory and fibrous components of the cyst wall in situ. Attempts to excise the entire cyst wall or to perform formal hepatectomy for hydatid cysts have largely been abandoned because of increased surgical morbidity.
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Histology demonstrating biliary epithelium lining simple cyst.
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Ultrasonographic appearance of large simple hepatic cyst.
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Computed tomography (CT) scan appearance of large hepatic cyst.
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Computed tomography (CT) scan of polycystic liver disease curiously limited to right liver.
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Hepatic cysts. Sagittal magnetic resonance imaging (MRI) reconstruction in patient with large echinococcal cyst; note daughter cysts in interior.
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Computed tomography (CT) appearance of biliary cystadenoma.
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Resection of involved liver in polycystic liver disease.
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Laparoscopic view of initial hepatic cyst puncture, before unroofing. Lesion is located high in right liver near the diaphragm.
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Laparoscopic view of beginning of unroofing of large simple hepatic cyst near dome of right liver.
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Drawing of final result of laparoscopic unroofing of a large simple hepatic cyst in right liver.
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Initial penetration of hepatic cyst with drainage of cyst fluid.
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Unroofing of hepatic cyst.
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Omentum sutured to excised margin.
