The treatment of hydatid disease of the liver: evaluation of an UK experience.

Aims: Hydatid disease of the liver though endemic in many countries, is rare in the UK. We evaluated a 16 year experience of treating hydatidosis and propose a management protocol. Methods: There were 30 patients. 14 (47%) males, median age 41 (range 25-72) years, 21 (70%) were symptomatic. Diagnosis was by serological tests and imaging. All had disease confined to the liver and received pre-operative drug therapy. Results: Twenty six (87%) patients received two cycles of albendazole 400 mg twice daily for 28 days, with a 14 day break in between. Four (13%) patients received Praziquantel at 50 mg/Kg/day, for two weeks. All patients underwent surgery. Subtotal cystectomy was carried out on 29 (96%) of patients one patient required a segmentectomy. Cystobiliary communications were identified in 15 (50%) of patients which were over sewn using fine absorbable sutures. Of these, seven had the bile ducts decompressed using a drain, with only one developing a post operative bile leak. In comparison, eight were not drained of which six leaked (P = 0·03). The median post operative hospital stay was eight days (range 5-24). Patients who developed post operative bile leaks however, needed prolonged abdominal drainage for a median of 21 days (range 18-24). Two (7%) patients developed histologically proven recurrent disease. The median follow up was 56 months (range 3-87). Conclusion: Surgery should be carried out after adequate drug therapy. Cystobiliary communications are common and when identified, should result in the biliary system being drained, to avoid post operative bile leaks. [ABSTRACT FROM AUTHOR]