Surgical treatment of liver echinococcosis

Objective. To improve the results of treatment of patients with liver echinococcosis and carry out a comparative assessment of techniques of surgical treatment depending on the nature of postoperative complications, hospital stay and antirecurrent efficacy.

Materials and methods. The experience of complex examination and treatment of 65 patients with liver echinococcosis for the period of 1999-2019 was analyzed. Open echinococectomy was performed in 21 patients, atypical liver resection – in 18 patients, anatomical liver resection – in 14 patients, pericystectomy – in 10, laparoscopic echinococectomy – in 1, percutaneous puncture of an echinococcal cyst under ultrasound control – in 1 patient.

Results. The time of inpatient treatment of patients after open echinococectomy was 23.5 ± 4.3 days, after pericystectomy – 19.8 ± 1.4 days, after liver resection – 14.4 ± 2.7 days, after laparoscopic echinococcectomy – 6, after percutaneous puncture echinococcal cyst – 7 days. Postoperative complications were observed in 52.4 % of patients who underwent open echinococectomy, in 20 % of patients after pericystectomy, and in 15.6 % after liver resection. There were no relapses of liver echinococcosis in all the groups. Mortality was 1.5 % and was recorded after open echinococectomy.

Conclusions. The most effective techniques for preventing postoperative complications are pericystectomy and liver resection. The duration of surgery and the average length of hospital stay with minimally invasive methods of treatment are shorter. However, the use of these methods of treatment remains controversial due to the possibility of intra-abdominal spread of the parasite. Patients with parasitic liver cysts after surgical treatment are subjected to dynamic follow-up observation (ultrasound examination of the liver, enzyme-linked immunosorbent assay, computed tomography of the abdominal organs) after 3-6 months for at least 5 years.