Surgical treatment of echinococcus in liver

Liver echinococcusis (LE) is an important medical problem in many countries in the world. In our country LE is an endemic disease with the incidence of 3,8 per 100 000 inhabitants. It has two forms: cystic echinococcosis and alveolar echinococcosis which are caused by the metacestode stages of Echinococcus granulosus and Echinococcus multilocularis. In our study we have presented the 40 year old experience in the treatment of LE at the Surgical clinic in Nish where we emphasize that surgery remains the first choice for treatment despite the introduction of the new therapeutic procedures in the recent years (chemotherapy with benzimidazole compounds and PAIR procedure). We gave the basic points of the surgical treatment of the LE as well as the indications for radical and conservative surgical operations. We have especially notified the importance of new diagnostic procedures for making the correct diagnosis and precise localization of the cysts (ultra­sound, CT and immunological tests). In the last 40 years at our clinic a total of 249 patients were operated because of LE. The most frequent localization of the cyst was in the right liver lobe(167 patients-67,05%) while 55 patients (22,08%) had complicated cysts. The majority of operated patients underwent conservative surgical procedures (160 patients - 64,25% ) with the overall postoperative morbidity of 14,45%. The most usual complication of the cyst was its rupture into the bile duct and consecutive presence of cysto-biliary communication (in 16 patients-6,42%) that was managed in 11 (68,75%) cases with simple suturing of communication. We have concluded that the introduction of these diagnostic and therapeutic methods in the treatment of LE has significantly decreased postoperative morbidity and mortality rate.