Year 2011 / Volume 103 / Number 9
Original
Profile of patients with hepatic hydatid disease not treated surgically

pp. 448-452

José Manuel Ramia, Roberto de la Plaza, Miguel Casares, Carmen Ramiro, Pilar Veguillas, José Quiñones y Jorge García-Parreño

Abstract
Background: hepatic hydatid disease (HHD) is still an important health problem in certain areas of Spain where it is endemic. The treatment of HHD is usually surgical but certain patients are found
to be ineligible after assessment for surgery (asymptomatic disease, comorbidity, patient refusal, or other).

Material and methods: description of patients assessed in the
Department of Surgery for hepatic hydatid disease.
Results: in a group of 70 patients with HHD, 27 patients were not treated surgically (mean age: 72.7 years [range: 47-97], 14 women [51.8%]). The number of cysts presented by these patients
was 33, with 1.22 cyst/patient (range: 1-4). The cyst size was 5.5 cm (range: 2.1-12.5 cm). The cysts, according to the WHO classification,
were CE1: 3 patients, CE3B: 5 patients, CE4: 10 patients and CE5: 9 patients. The form of presentation was: symptomatic in 9 patients, although only 6 were attributable to HHD (22%) and asymptomatic in 18 patients. In these cases, imaging was performed for study of tumor extension in 6 patients and diverse medical reasons
in 12. Only two therapeutic interventions were performed: endoscopic retrograde cholangiopancreatography (ERCP) with insertion
of a bile duct stent, and puncture-aspiration-injection-re-aspiration (PAIR), both in patients who did not wish to undergo surgery.

Ten patients had surgical indications: CE1 (3 patients), CE3B (5 patients), CE4 (1 patient), and CE5 (1 patient). The reasons why the patients did not undergo surgical treatment were: refusal (9
patients) and advanced neoplasm (1 patient). Surgery was judged necessary in 5 patients. In the mean follow-up period of 17 months (range: 1-37), no surgery was performed.

Conclusions: there were various causes for not performing surgical intervention of HHD after medical evaluation: asymptomatic patients, older patients, patients with multiple pathologies and oncologic patients. Usually, they were patients who voluntarily chose not to undergo surgery.
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José Manuel Ramia, Roberto de la Plaza, Miguel Casares, Carmen Ramiro, Pilar Veguillas, José Quiñones y Jorge García-Parreño. Profile of patients with hepatic hydatid disease not treated surgically. 448-452


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