Improved techniques in the surgical treatment of hepatic hydatidosis.

We evaluated 64 patients with hepatic hydatidosis who were treated during 1982 to 1988. The main clinical manifestations were epigastric pain (84 per cent), hepatomegaly (31 per cent), fever (30 per cent) and jaundice (25 per cent). Five patients were asymptomatic. All diagnoses were established by ultrasonography and computed tomography, or both (sensitivity rates of 95 and 93 per cent, respectively). Treatment was exclusively surgical and there were no deaths. In the five patients in group 1, total cystectomy was done without morbidity. The 19 patients in group 2 underwent a limited capsectomy, evacuation of the cyst, omentoplasty, suturing of the biliary communications and drainage of the residual cavity, with a rate of morbidity of 42 per cent. In the 40 patients in group 3, a wide capsectomy and unroofing of the cyst were done, the contents were removed, the cavity edges were hemostatically oversewn and the residual hepatic cavity was drained through a high vacuum, closed drainage system. Omentoplasty was not routinely done. With this technique, the rate of morbidity was reduced to 2.5 per cent. Of 64 patients, 32 were observed for an average of 42 months with a recurrence rate of 9 per cent. Because of the low rate of postoperative morbidity, recurrence and the shorter period of hospitalization, the surgical technique used in group 3 seems to be an efficient method for hepatic hydatidosis.