Keywords: liver hydatid cyst, surgical treatment, minimally invasive methods
Introduction The hydatic disease is a severe, potentially lethal disease
caused by Echinococcus granulosus larvae. The infection
with E. granulosus should be seen as a challenge both
from a medical and economic point of view [1].
In Romania, the incidence of this pathology is
increasing, with 5-6 cases per 100.000 inhabitants each
year [2].
E. granulosus is a hermaphrodite flatworm with three
stages of development. The structure of the cyst is usually
made of three components: the pericyst, made of the host’s
inflammatory tissue, the exocyst and the endocyst, where
the scolecs and the proligere membrane are produced [3,4]
(Figures 1, 2).
The hydatic cyst occurs by accidental infection of the
human with the eggs of Echinococcus granulosus, followed
by the development of the larvae, most commonly in the
liver (50-70% of cases), and less commonly in the lungs,
spleen, kidneys and brain [5-7].
At this time, the WHO-IWGE classification sets
both the staging of hepatic hydatid cysts based on the
ultrasound aspect, and the therapeutic attitude depending
on this staging (Tables 1 and 2) (Figure 3) [8].
The therapeutic attitude towards hepatic hydatid
disease includes the medical treatment, surgical treatment,
endoscopic interventional treatment, as well as the
subsequent minimally invasive methods.
Regarding the classical surgical treatment, mortality is
around 0.9-3.6% and the recurrence rate is around 11.3%
in the first 5 years [9].
The classical surgery procedures used for the treatment
of the hepatic hydatid cyst are divided, according to their
attitude towards the pericyst, into procedures that do not
involve pericyst resection (cystectomy) and procedures
involving pericyst resection (partial pericystectomy,
pericystoresection, hepatectomy). They are associated
with procedures that should treat the remaining cavity:
external drainage with a drain tube, bipolar drainage
of the cavity and the main bile duct, padding, omental
DOI: 10.25122/jml-2018-0045
203
Journal of Medicine and Life Vol. 11, Issue 3, July-September 2018 204