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Page 2 of 9 Mansy et al. Mini-invasive Surg 2018;2:36 I http://dx.doi.org/10.20517/2574-1225.2018.48

[2]
Mediterranean Sea and Middle East where there is contact with infected animals . During our study, we
discovered increasing incidence of liver hydatid disease. And surprisingly, we get no feedback regarding
animal contact in some patients. Camels were the only contact animal in other patients.

Different management modalities were discussed before in literature, but surgery remains the standard
treatment. Operative modalities range from complete resection (e.g., total pericystectomy or hepatectomy)
[3]
to minimal invasive procedures (e.g., percutaneous aspiration of cysts) . More recently, laparoscopic
[4]
approaches take a hand in the treatment of hepatic hydatid cysts .

Choosing the appropriate modality for management depends on several factors: number & site of the cysts,
patient general condition, type of hospital in which the surgery is performed, including the possibility of
[5]
intensive postoperative care and the surgeon’s expertise .
Radical treatment modality focuses on near total or total hepatic adventitia resection with or without
hepatic parenchyma resection associated, which avoids residual cavity .
[6]
Here in our study, we assess our experience in radical treatment especially total pericystectomy in
management of hepatic hyatid cyst.

METHODS
Patients and methods
In this retrospective study, we analyzed 103 patients with hydatid cyst managed at the Advanced Hepato-
Pancreatico Biliary Center, Zagazig University Hospitals, from June 2011 till May 2018. All data as clinical,
radiological, laboratory, operative, and post-operative were recorded. Comorbidity, operative morbidity
and mortality, surgical procedure, length of postoperative hospital stay were also recorded.

The diagnosis was made mainly on radiological appearance (ultrasonography was the imaging of choice).
In doubtful cases we also combined radiology with serology (enzyme-linked immunosorbent assay) and
Triphasic CT which was used to assess location, diameter and number of cysts. We used plain x-ray chest
to identify lung hyatid cyst. Magnetic resonance cholangiopancreatography (MRCP) was performed for
patients with hydatid cyst more than 5 cm in diameter, recurrent and multiple cysts to assess cysto-bilary
communications. Endoscopic retrograde cholangiopancreatography (ERCP) restricted to patients presented
with preoperative obstructive jaundice.

Albendazole 400 mg twice daily was prescribed for two weeks prior to surgery to inactivate the organism.
During the follow up period Albendazole was given with the same doses for 3 and 6 months in complicated
and recurrent cases. In cirrhotic patients we reduced the dose to 200 mg twice daily for 1 week pre-
operative and for 3 months postoperative.

Surgical technique
Surgeries were done by trained surgeons. Epidural catheter was used for postoperative pain management.
J shaped incision “Makuuchi” was the chosen approach for good exposure. But, bilateral subcostal incision
used in cases needed splenectomy. Complete liver mobilization, identification of the cyst (site and number),
search for other associated cysts (intestine or kidney) followed by gauze towels soaked in hypertonic saline
used to isolate the lesion and safeguard against the risk of spillage of cyst contents into the peritoneal
cavity, were the routine steps.

In cases where the cyst was deep intra-parenchymal, we used intra-operative U/S to identify the proper
site. Harmonic shears were used to achieve good haemostasis during liver parenchyma dissection. Also, in