Radical treatment for hepatic echinococcosis

Background: Hydatid liver surgery is associated with a high incidence of recurrence. Combined medical and surgical treatment should decrease the recurrence rates. Methods: In a retrospective study, 75 patients receiving operative treatment for hepatic echinococcosis with or without albendazole therapy were invited to enter a follow-up survey. Patients were examined clinically, and hydatid serology and B-mode ultrasound were performed. The initial results were evaluated by a panel and patients with equivocal results were further studied with diagnostic aspiration and direct microscopic examination for protoscolices. Results: Thirty-nine patients (52%) responded and 36 were followed up (22 in Group I with operation plus albendazole; 14 in Group 2 with operation alone). Although recurrence could not be excluded in 24 of these patients (18 Group I, 6 Group 2) when the initial results were evaluated, diagnostic aspiration revealed protoscolices in only two of them. One of these patients was excluded from the study because of inapproriate usage of albendazole. The recurrence rate was therefore 5%. Discussion: The recurrence rate in this study is lower than that obtained in our previous experience, but it does not represent a significant benefit for combined ('radical') treatment of echinococcosis. Data obtained from the follow-up studies are confusing for most of the parameters and indicate that the present methods for assessment are unsatisfactory for evaluating the treatment of hepatic echinococcosis