The Albendazole role in the treatment of hepatic hydatidosis. A surgical evaluation.

From January 1988 to December 199, 31 patients with hepatic hydatidosis have been treatad in our center, 18 males and 13 females. The mean age 52.7 years, the range 20-66 years, 70.3% were solitary cysts. A bilateral subcostal incision preferred, in only three pts. with single left lobe cyst mid-line incision performed. One patient with right lung involvment needed thoracic extension of the abdominal incision. The most common symptoms related to the presence of an abdominal mass. In seven patients the cyst(s) incidentally discovered while undergoing ultrasound for presumed gallbladder pathology. Fever and abdominal pain often present. All pts. received a preoperative ultrasound. A CT-scan, HIDA and arteriography were used as well. In regards to the preoperative therapy administred mebendazole in 4 patients, albendaole in 2 and nothing in three pts. A1bendazole treatment consisted of three cycles of 28 days each; there medication-free period of 14 days beetween cycles. A CT-scan performed at the beginning and at the end of the albendazole therapy, ultrasound evaluation performed between the cycles. In seven pts. noticed direct involvment of the extrahepatic biliary tract via fistula evaluated intraoperatively with cholangiography. Five of these patients had jaundice caused by the common bile duct being obstructed by hydatid vescicles. In all patients performed total cystopericystectomy. In 18 pts. the cyst removed intact. A hepatic resection never necessary. One patient died (N 21) in the postoperative period due to hepatic insufficiency, his old age and significant intraoperative blood loss. Three pts. developed biliary fistulas (pts. N 15, 21 29) while in another case large subphrenic abscess forced to reoperate on the patient. We had disease recourrences. The mean hospitalization period 17.2 days. Albendazole gave two main advantages: a) preoperative parasiticyde effect b) a complete excision of the cyst wall from the parenchyma was made easier.