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Hydatid cyst of the liver is a parasitic disease caused by Echinococcus granulosus. The principal complications are infection, biliary duct fistula, and rupture into the peritoneum or chest. Diagnosis has become easier with advances in ultrasonic imaging and CT scanning. Surgery remains the most effective treatment but postoperative complications arise in 30% of cases, particularly when the surgical approach is conservative. Radical surgical approaches give better results and should be used in most cases. Biliocutaneous fistula and infection of the residual cavity are the most common postoperative complications and result in prolonged hospitalization and excess costs. New therapeutic strategies incorporate endoscopic, percutaneous, and medical therapies with surgery and have allowed an improvement in morbidity and mortality due to hydatid cysts of the liver. Until immunization becomes a possibility, preventive measures are necessary to avoid disease recurrence.

Hydatic cysts of the liver can rupture into the thorax. The aim of this work was to demonstrate how abdominal access can be used in most cases. We report 44 cases of hydatic cysts which ruptured into the thorax among a series of 1411 hydatic cysts of the liver operated between 1974 and 1995. Abdominal ultrasound and chest x-ray provided the diagnosis preoperatively in 35/42 operated cases (one case of spontaneous elimination of a hydatic membrane via a cutaneous orifice and one case of preoperative death). Thoracophrenolaparotomy was used in 12 cases, thoracotomy with laparotomy in 6, thoracotomy alone in 5 and laparotomy alone in 19. Pulmonary resections were performed in 18 cases. No procedure could be performed in one patient who died at the beginning of surgery. A breach in the diaphragm was repaired in 41 cases. The dome of the cyst was resected in 29 cases and complete pericystectomy was performed in 12. There were 7 post-operative deaths. There were no deaths in the abdominal access patients. All emergency problems were controlled with abdominal access. Thoracic access was reserved for specific cases.