Clinical scienceSurgical treatment of hydatid disease of the liver: 25 years of experience
Section snippets
Pathophysiologic basis of surgical management
The adult tape worm consists of a head (scolex) and 3 following segments (proglottides). The scolex has 4 suckers and a prominent rostellum armed with a double row of 30 to 36 hooks. Sexual, mature organs and countless eggs are contained in the more distal of the 3 proglottides. Each egg consists of a shell containing 6 hook-armed embryo hexacanth (6 hooks), as shown in Figure 1. The adult tapeworm lives in the small bowel of its most common definitive host, the dog, attached to the mucosa by
Patients
Patients were identified by a computer-based indexing system containing data on all patients admitted for LHD at the First Department of Surgery of the University of Rome “La Sapienza” Medical School between January 1, 1980, and January 1, 2005. The overall study group was divided into 2 subgroups: group A (1980–1992) and group B (1993–2005). Criteria for exclusion from this study were previous medical or surgical treatment for HD, concomitant extrahepatic HD, and the presence of a
Results
The present study included 454 patients. Table 1 lists their demographic and clinical characteristics. Results of serologic tests (hemagglutination, complement fixation) were positive in 69% of 454 patients. A total of 695 hepatic cysts were treated. Table 2 shows the characteristics of the cysts and their distribution. Cysts were solitary in 296 patients and multiple in 158 (one lobe in 85, both lobes in 73). A total of 417 cysts were classified as deep: 314 were sited in the right lobe, 72 in
Comments
The desired goals for the treatment of LHD include complete elimination of the parasite and prevention of recurrent disease with minimum mortality.7 However, selection of the most appropriate treatment to achieve these goals remains the subject of debate, and 3 main approaches are used to date: systemic chemotherapy, percutaneous procedures, and surgical treatment. Systemic chemotherapy is presently based on benzimidazole carbamate compounds. However, the clinical efficacy of these treatments
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