Surgical management of liver hydatidosis: a multicentre serie of 1412 patients

Liver International : article- full text to be published – the January 2010 issue.
CLINICAL STUDIES

Surgical management of liver hydatidosis: a multicentre series of 1412 patients

Mario A. Secchi 1 , Ricardo Pettinari 2 , Carlos H. Mercapide 3 , Ricardo Bracco 4 , Carlos Castilla 5 , Eduardo
Cassone 6 , Pablo Sisco 7 , Oscar Andriani 8 , Leonardo Rossi 9 , Jorge Grondona 10 , Lisandro Quadrelli 1 ,
Raúl Cabral 2 , Nicolás Rodríguez León 1 and Carlos Ledesma 3

1 Department of Surgery, Hospital Italiano Garibaldi and Medical School IUNIR, Rosario, Argentina
2 Department of Surgery, Hospital Regional, C. Rivadavia, Argentina
3 Department of Surgery, Hospital Artemides Zatti, Viedma, Argentina
4 Department of Surgery, Hospital Interzonal, Mar del Plata, Argentina
5 Department of Surgery, Hospital General San Martín, La Plata, Argentina
6 Department of Surgery, Hospital Central de Mendoza, Mendoza, Argentina
7 Department of Surgery, Hospital Pirovano Buenos Aires, Argentina
8 Department of Surgery, Fundación Favaloro, Buenos Aires, Argentina
9 Department of Surgery, Clínica Modelo de Rufino, Santa Fe, Argentina
10 Department of Surgery, Centro Médico de San Isidro, Buenos Aires, Argentina

Correspondence
Professor Mario A. Secchi, Clinica Quirúrgica I, Medical School IUNIR, Servicio de Clínica Quirúrgica 'B',
Hospital Italiano, Virasoro 1249, 2000 Rosario, Argentina
Tel: +54 341 4858 893
Fax: +54 341 4825 065
e-mail: secchimario@hotmail.com

KEYWORDS
echinococcus • hydatid disease • liver • parasitic cyst • surgery
ABSTRACT
Background: The management of hydatid liver disease (HLD) includes various nonsurgical and surgical
treatment options.

Methods: The purpose of the present longitudinal study was to report the changes in surgical management and the consequent outcome of HLD patients in 10 referral surgical centres in Argentina from 1975 to 2007. The study result analysis was divided into two study periods (1975–1990 and 1991–2007).
Results: A total of 1412 patients underwent radical (Group 1: 396 patients), conservative (Group 2: 748 patients) or combined (Group 3: 536 interventions in 268 patients) surgical procedures. The overall mortality and complication rate (Clavien I–IV) was 1.8 and 39% respectively. The complication rate was significantly lower in Group 1 (26%) compared with Group 2 (45%) and Group 3 (42%) There was a significant decrease in mortality (2.3 vs. 1%), complication (42 vs. 34%) and early reoperation (12 vs. 6%) rates between the first study part (918 patients) and the second study part (494 patients). During a median follow-up of 7 years, there was a significant decrease in the first part of this study in the late reoperation rate (8.4–3%) and indisease recurrence (9–1.6%).
Conclusion: This large national observational multicentre series shows a significant improvement in surgical management of HLD in Argentina, with a decrease in mortality, morbidity, early and late reoperation and recurrence rates. A recent trend was observed in favour of an earlier diagnosis, less complicated clinical presentation and recent use of minimally invasive approaches.

Received 21 May 2009 at Liver International
Accepted 6 August 2009 : Full text published in the January 2010 issue
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1478-3231.2009.02116.x About DOI