Pp. 203–209 Hepatic hydatid cyst – diagnose and treatment algorithm

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

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Journal of Medicine and Life Vol. 11, Issue 3, July-September 2018
204