Long and short-term outcomes of patients undergoing surgery for hydatid cyst

Introduction and Objective: The optimal approach to the treatment and follow-up of hepatic hydatid disease remains unclear. Surgery is still considered the gold standard. In this study, we aimed to contribute to the literature by analyzing the outcomes of patients who underwent surgery for hydatid cysts, comparing conservative and radical surgical procedures, assessing the association with significant morbidities and recurrent disease, and identifying predictive factors. Our goal is to reduce the medical and economic burden of these outcomes and to provide a more accurate approach to the surgical treatment and follow-up of this condition. Materials and Methods: The study retrospectively analyzed the data of 59 patients who underwent surgery for hepatic hydatid cysts at the Department of General Surgery, Çukurova University Faculty of Medicine, between August 2011 and May 2022. The data analyzed included demographic information, preoperative and postoperative laboratory results, serological test results, radiological imaging, invasive procedures, medical treatments, surgical techniques and findings, postoperative hospital stay duration, morbidity, and recurrence rates. Results: The patients were divided into two groups: the conservative surgery group (Group 1, 30 patients) and the radical surgery group (Group 2, 29 patients). The mean age was 42.27±17.05 years in the conservative group and 44.21±13.31 years in the radical group. Both groups had a balanced gender distribution, and complication rates were found to be 16.67% in the conservative group and 20.69% in the radical group (p>0.05). Bile leakage and abscess significantly prolonged hospital stay (p<0.05). Patients with segment 4 cysts had a significantly higher incidence of bile leakage and cysto-biliary communication (p<0.05). Preoperative levels of Alkaline Phosphatase (ALP) and Gamma-Glutamyl Transferase (GGT) were significantly higher in patients with cysto-biliary communication (p<0.05). The recurrence rate was significantly higher in the conservative group (26.67%) compared to the radical group (3.45%) (p<0.05). Conclusion: The choice of procedure in hepatic hydatid surgery can be individualized based on factors such as the number and location of cysts. In experienced centers, radical surgical procedures with a lower risk of recurrence may be preferred over conservative surgery, given the similar morbidity risk. For patients with elevated preoperative ALP and GGT levels and those with segment 4 cysts, extra caution should be exercised regarding cysto-biliary communication, and appropriate measures should be taken during surgery to reduce bile leaks and hospital stay. In recurrence follow-up, the use of serological tests such as EIA and commercial Western blot IgG, which remain positive in the short term, may increase costs if used routinely in daily practice.