When is surgery indicated for hydatid cysts of the liver?

Updated: Jun 12, 2018
  • Author: Robert E Glasgow, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

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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