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. 2006;8(3):189–193. doi: 10.1080/13651820500539495

Table III. Algorithm for the surgical management of liver hydatidosis.

Indications for surgery 28:

  • Large liver cysts (>4 cm) with multiple daughter cysts

  • Single superficially situated liver cysts that may rupture spontaneously

  • Infected cysts

  • Cysts communicating with the biliary tree

  • Cysts causing pressure on adjacent vital organs

Surgical approach:

  • Cysts in the left or lower right liver lobe: abdominal (open or laparoscopic)

  • Cysts in the higher right liver lobe: thoracic or thoraco-abdominal

  • Superficially/peripherally located cysts: <4 cm – pericystectomy >4 cm – drainage and cystectomy

  • Deeper located cysts: <4 cm – medical treatment and/or PAIR >4 cm – drainage and cystectomy

Cavity management:

  • Omentoplasty or

  • Closed suction tube drainage (for cysts located in the dome of the liver or if the omentum is not available for obliteration)

Biliary fistula/intra-biliary rupture:

  • In selected jaundiced patients, ERCP prior to surgery

  • Identification and suturing of the bile communication

  • Common bile duct exploration/lavage

  • T-tube or bilio-digestive anastomosis

PAIR technique, transcutaneous puncture under US guidance; ERCP, endoscopic retrograde cholangiopancreatography.