Complicated forms
Breakthrough of a cyst into the bile ducts is manifested by jaundice and cholangitis - the operation includes choledochotomy with removal of daughter bubbles from the ducts and drainage; festering cysts are sanitized as abscesses with subsequent elimination of the cavity; during dissemination throughout the peritoneum and pelvis, all accessible foci are removed, the remaining ones are suppressed by long-term albendazole. Related specialists (hepatobiliary surgeon, gynecologist) are often involved. Rehabilitation is individual; observation - at least 5 years with serology.
Indications
- recurrent echinococcosis after operations;
- complicated forms: breakthrough into the bile ducts and abdominal cavity, suppuration, calcification;
- multiple lesions of the liver, abdominal cavity and pelvis;
- cysts of inaccessible segments, combination with organ resection.
Surgery for relapse and complications
Recurrent and complicated echinococcosis is the most difficult chapter of parasitic surgery: scars and adhesions after previous operations, cysts in the posterior segments, fistulas with bile ducts require open access, wide exposure and mastery of resection techniques. Radicality (removal of germinal elements completely) + aparasitism + chemotherapy with albendazole - three conditions under which repeated relapses can be avoided. Patients are managed with mapping of all lesions using MSCT/MRI before surgery and long-term observation after.
