Repeated cysts
Relapse occurs from daughter blisters left during the first operation or a new infection; Repeated surgery requires separation of adhesions, search for cysts using the preoperative MSCT map (including small ones) and particularly strict aparasitic control—contamination during recurrent surgery is unacceptable. Cavities after large cysts are eliminated by omentoplasty, bile fistulas are stitched. A course of albendazole before and after surgery is a mandatory part of the protocol, which reduces the risk of a new relapse to a minimum; further follow-up with ultrasound every 6 months.
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.
