Pp. 203–209 Hepatic hydatid cyst – diagnose and treatment algorithm

Conclusions
The lot was characterized by heterogeneity regarding the 
gender, age and environment of origin. There was a slight 
female predominance and an increased share of the 30-49 
age group. The age range was between 18 and 84 years old, 
mentioning the fact that the Surgical Clinic is one for adults.
From the clinical examination, we highlight the high 
percentage of asymptomatic patients, which confirms 
once again the high frequency of accidental diagnosis 
in hepatic hydatid cyst. The most frequent symptom at 
patients’ admission is represented by pain located at the 
level of the right hypocondrium, a nonspecific symptom. 
The fact that the results obtained are for cases referred for 
surgical treatment and may differ from those obtained at 
the first diagnosis (frequently in another clinic) and prior to 
treatment with Albendazole must not be forgotten.
Laboratory examinations revealed hepatic cytolysis 
syndrome most frequently with elevated ALT values (and in 
cases where additional hepato-biliary pathologies were not 
associated), inflammatory syndrome evaluated by a single 
parameter (fibrinogen) and eosinophilia (39% of cases).
As previously shown, there are several factors that can 
justify the clinical and paraclinical changes noticed besides 
the hydatid cyst. Among these, we can list associated 
comorbidities and the administered medication, diagnosis 
and treatment in other medical units, and prior treatment 
with Albendazole.
Imaging, especially the ultrasound examination, was 
the basis for pre-surgical characterization of cysts. Most of 
the cysts were CE3 and CE1 stages and, in terms of size, 
between 5 and 10 cm diameter. The right lobe has been 
affected in more than half of the cases.
Regarding the minimum invasive treatment, the MoCAT 
and PAIR techniques were used. Among the open surgical 
procedures, in 88% of the cases, the Lagrot technique 
was used. The comparison between classic and minimally 
invasive surgical treatment revealed fewer complications and 
fewer necessary days of hospitalization in favor of the latter.
Summarizing, the following can be said:
— patients with hepatic hydatid cyst form a 
heterogeneous group (taking into account 
gender, age, place of origin);
— semiology is poor and unspecific;
— among laboratory examinations, eosinophilia 
is a sign of concern that should place the 
hydatid liver cyst on the differential diagnosis 
list;
— imaging, most commonly in the form of 
ultrasound examination, the easy, cheap and 
non-irradiation method is the basis of the 
diagnosis of hepatic hydatid cyst;
— minimally invasive methods have high 
applicability, less frequent complications and 
shorter hospitalization;
— the therapeutic solution for the hepatic hydatid 
cyst remains the attribute of general surgery, 
both by the still important role of classical 
and laparoscopic surgical techniques and by 
the ability of surgery to provide therapeutic 
assistance to cases treated through minimally 
invasive techniques.