Pattern of Relapse in Hepatic Hydatidosis: Analysis of 238 Cases in a Single Hospital

• Published in: Journal of gastrointestinal surgery Vol. 24; no. 2; pp. 361 - 367
• Main Authors: Jaén-Torrejimeno, Isabel, López-Guerra, Diego, Prada-Villaverde, Aranzazu, Blanco-Fernández, Gerardo
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2020; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biliary Fistula - parasitology; Chronic Disease; Cysts; Echinococcosis, Hepatic - complications; Echinococcosis, Hepatic - pathology; Echinococcosis, Hepatic - surgery; Female; Gastroenterology; Gastrointestinal surgery; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Original Article; Postoperative Complications - etiology; Recurrence; Retrospective Studies; Surgery; Time Factors; Young Adult; Cystic echinococcosis; Relapse; Hepatic hydatidosis; Treatment; Morbidity
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-019-04163-7

Introduction
Hydatidosis is a chronic disease that is endemic and prevalent in certain regions of the world. Surgical treatment is the best option, although its main problem is that there is a high rate of recurrence. The objective of the present study was to assess its therapeutic management and the factors related to its postoperative morbidity and relapse.
Material and Methods
A descriptive and retrospective study was made of 238 patients with hepatic hydatidosis operated from January 2006 to December 2017 at our center. An analysis was made of the variables associated with postoperative morbidity and relapse, and of the temporal pattern of that relapse.
Results
Out of 238 patients, radical surgery was performed in 132 (55.5%) and partial cystectomy in 106 of them (44.3%). The postoperative morbidity was 42% (100/238) and the relapse rate was 7.2% (17/238). The factors associated with greater postoperative morbidity were partial cystectomy (OR, 2.83 (1.47–5.43);
p
 = 0.002), ≥ 2 cysts (OR, 3.22 (1.51–6.86);
p
 = 0.002), and biliary fistula (OR, 4.34 (2.11–8.91);
p
 < 0.0001); and those associated with higher relapse rate were history of hydatidosis (OR, 4.98 (1.76–14.11);
p
 = 0.003) and ≥ 2 cysts (OR, 3.23 (1.14–9.11);
p
 = 0.027). The first relapses appeared after 14 months, with the greatest incidence between 14 and 36 months.
Conclusions
The surgical procedure applied is associated with morbidity but not with that of relapse. The observed relapse pattern demonstrates the need to maintain long-term follow-up, but with no follow-up being necessary in the first year. Broader multicenter and prospective studies are needed to establish more precise recommendations.