A combined medical and surgical approach to hydatid disease: 12 years' experience at the Hospital for Tropical Diseases, London

There is no consensus as to the most appropriate treatment for the varied and often complicated presentations of hydatid disease in Britain. We looked at our own results over a 12-year period to see if a consistent and logical plan had emerged. 70 patients presenting between 1986 and 1998 were analy...

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Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2002-03, Vol.84 (2), p.100-105
Main Authors: Ayles, H M, Corbett, E L, Taylor, I, Cowie, A G A, Bligh, J, Walmsley, K, Bryceson, A D M
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Albendazole - therapeutic use
Anthelmintics - therapeutic use
Anticestodal Agents - therapeutic use
Child
Combined Modality Therapy
Drug Therapy, Combination
Echinococcosis - drug therapy
Echinococcosis - surgery
Enzyme-Linked Immunosorbent Assay
Female
Humans
Male
Middle Aged
Praziquantel - therapeutic use
Preoperative Care - methods
Recurrence
Retrospective Studies
Treatment Outcome
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Summary:There is no consensus as to the most appropriate treatment for the varied and often complicated presentations of hydatid disease in Britain. We looked at our own results over a 12-year period to see if a consistent and logical plan had emerged. 70 patients presenting between 1986 and 1998 were analysed retrospectively, with regard to their presentation, diagnosis, treatment and outcome, with particular reference to the use of chemotherapy, and to the difficulties of post-treatment assessment by serology and imaging. 37 patients had been treated previously. 35 had hepatic cysts and 26 multiple cysts. 4 patients were treated by surgery alone, 44 by chemotherapy and surgery, and 14 by chemotherapy alone. The combined use of albendazole and praziquantel pre-operatively reduced significantly the number of cysts that contained viable protoscolices: 1/25 versus 5/8 that received albendazole alone (P = 0.00013). During the 12-year period, it became our policy to aim for 3 months drug treatment (albendazole throughout with praziquantel for 2 weeks), re-assess and proceed either to surgery or to continue with chemotherapy. It is possible to construct an algorithm for the management of patients with hydatid disease by chemotherapy and surgery, but the assessment of results by indirect techniques remains difficult.
ISSN:0035-8843
1478-7083