Current Concepts in Curative Surgery for Cystic Echinococcosis of Liver

Abstract

Cystic echinococcosis (CE) may cause unspecific symptoms like abdominal discomfort in the right upper quadrant of the abdomen due to capsule tension pain of the liver related to an increased expansion of the cyst. Further, a growing cyst may put pressure on intrahepatic bile ducts or can get direct access to the biliary system with complications like obstruction, cholangitis and fistulas. Large or rapid growing cysts may cause compression of blood vessels with thrombosis or Budd-Chiari syndrome. However, the vast majority of patients with CE of the liver is asymptomatic. CE of the liver can be cured surgically in many cases. In the past, cystectomy with resection of the pericyst components was performed as a standard. The today’s parenchymal sparing state-of-the-art surgery is endocystectomy combined with partial cystectomy. This procedure includes (i) evacuation of paracyte-derived cyst content, (ii) sterilization of the cyst wall (host) and (iii) deroofing of the cyst (partial cystectomy). Here the advantages, risks and outcomes of the surgical approaches are discussed, and the need for an interdisciplinary treatment of these patients is outlined.