Cystic echinococcosis (CE) is a chronic, complex, zoonotic disease caused by Echinococcus Granulose tapeworms. The disease may present with a variety of symptoms, ranging from asymptomatic to fatal. Surgical intervention is the primary treatment modality for CE. Despite advances in surgical techniques and chemotherapy, disease recurrence remains a major concern. Therefore, we aimed to determine the true rate of CE recurrence after primary resection and identify possible factors that increase the risk of recurrence. A systematic search of Medline, PubMed, Embase, and Cochran Library was conducted to identify studies reporting the incidence of CE recurrence after primary radical surgery. Data were pooled using random effect models. The disease prevalence was determined by calculating the ratio of CE recurrence and the total number of patients. A meta-regression was conducted to identify any potential factors linked to recurrence. A total of 38 eligible studies, with a total of 6,222 CE patients who underwent primary surgical removal, revealed a pooled recurrence rate of 8% (95% CI: 6%-10%). However, significant heterogeneity was observed (I2 p-value <0.001). Subgroup analysis by region showed the highest incidence of recurrence in European and Turkish studies, with rates of 11% (95% CI: 7%-17%) and 9% (95% CI: 5%-14%), respectively. The lowest recurrence rate was observed in Asian studies, with a rate of 4% (95% CI: 2%-7%). Moreover, the non-radical intervention has a recurrence of 5% (95%CI: 4%-7%), radical 7% (95%CI: 6%-9%), and studies that contained both interventions have 10% (95%CI: 6%-16%), P-value= 0.04. This is the first meta-analysis to evaluate the overall incidence of CE recurrence after primary surgical removal. The study also revealed a substantial degree of heterogeneity across the included studies and indicated possible risk factors for higher recurrence rates, such as the study's geographic area, type of surgery and the year it was published. These findings will help to guide future research in developing effective strategies to prevent or reduce CE recurrence and improve patient outcomes.

Echinococcosis is a zoonotic parasitic disease caused by Escherichia larvae. It frequently involves the liver (70%-75%), followed by the lungs (15%-20%), and occasionally the brain, heart, spleen, bone, and other organs. The main pathogenic forms of human echinococcosis currently include cystic echinococcosis (CE) and alveolar echinococcosis (AE). CE is globally distributed, while the distribution of AE is generally restricted to the northern hemisphere. In China, CE accounts for 75% of all echinococcosis cases. With rapid advances in surgical techniques in recent decades, the surgical strategy for CE has changed, especially with the continuous improvement of surgical methods and the expansion of surgical contraindications. To further understand the changes in surgical treatment strategies for hepatic CE, we interpreted and analyzed the existing literature addressing the surgical treatment of hepatic CE both domestically and abroad and briefly summarized them in chronological order. This review aims to provide a deeper understanding of the progress in the surgical treatment of hepatic CE to provide clearer avenues for its clinical diagnosis and treatment.

We aimed to determine the effective factors in the selection of treatment methods for patients with hepatic hydatid cyst undergoing surgery and the variables effective when performing postoperative endoscopic retrograde cholangiopancreatography (ERCP). In addition, we aimed to reveal the factors affecting the recurrence, postoperative complications, and length of stay of these patients.

A total of 107 patients diagnosed with hepatic hydatid cysts were treated surgically. Data were obtained from the records of these patients. Chi-square test was used for the analysis. The variables that were found to be significant in the chi-square analysis were included in the logistic regression (Backward: LR) analysis.

Of all patients, 6.5% underwent the puncture, aspiration, injection, and reaspiration (PAIR) technique, 67.3% underwent conservative surgery, and 26.2% underwent radical surgical treatment. In paired comparisons, a significant difference was found among the ultrasonographic size of the cyst (p = 0.033), the radiological classification of the cyst (0.006), and history of previous surgery and treatment methods for the cyst. The risk of performing ERCP was 25.710 [95% confidence interval (CI): 1.721-284.013] folds higher for cysts located in the left lobe, whereas it was 19.992 (95% CI: 2.004-199.488) folds higher for cysts located in both right and left lobes. When the radical surgical treatment method was taken as a reference, the status of ERCP implementation was 29.785 (95% CI: 1.844-480.996) folds higher for PAIR and 3.628 (95% CI: 0.355-37.103) folds higher for conservative surgery.

In conclusion, radical surgery is a significant treatment for hepatic hydatid cyst as its ultrasonographic cyst size increases with time. The location and treatment method of the cyst increases the complication of biliary fistula and requires ERCP.

In patients with hepatic cystic echinococcosis (CE), treatment effectiveness, outcomes, complications, and recurrence rate are controversial. Endocystectomy is a conservative surgical approach that adequately removes cyst contents without loss of parenchyma. This conservative procedure has been modified in several ways to prevent complications and to improve surgical outcomes. This systematic review aimed to evaluate the intraoperative and postoperative complications of endocysectomy for hepatic CE as well as the hepatic CE recurrence rate following endocystectomy.

A systematic search was made for all studies reporting endocystectomy to manage hepatic CE in PubMed, Web of Science, and Cochrane CENTRAL databases. Study quality was assessed using the methodological index for non-randomized studies (MINORS) criteria and the Cochrane revised tool to assess risk of bias in randomized trials (RoB2). The random-effects model was used for meta-analysis and the arscine-transformed proportions were used to determine complication-, mortality-, and recurrence rates. This study is registered with PROSPERO (number CRD42020181732).

Of 3,930 retrieved articles, 54 studies reporting on 4,058 patients were included. Among studies reporting preoperative anthelmintic treatment (31 studies), albendazole was administered in all of them. Complications were reported in 19.4% (95% CI: 15.9-23.2; I2 = 84%; p-value <0.001) of the patients; biliary leakage (10.1%; 95% CI: 7.5-13.1; I2 = 81%; p-value <0.001) and wound infection (6.6%; 95% CI: 4.6-9; I2 = 27%; p-value = 0.17) were the most common complications. The post-endocystectomy mortality rate was 1.2% (95% CI: 0.8-1.8; I2 = 21%; p-value = 0.15) and the recurrence rate was 4.8% (95% CI: 3.1-6.8; I2 = 87%; p-value <0.001). Thirty-nine studies (88.7%) had a mean follow-up of more than one year after endocystectomy, and only 14 studies (31.8%) had a follow-up of more than five years.

Endocystectomy is a conservative and feasible surgical approach. Despite previous disencouraging experiences, our results suggest that endocystectomy is associated with low mortality and recurrence.

Hydatid cysts of the liver are benign lesions which require a wide range of surgical strategies for their treatment. We hypothesized that cysts larger than 15 cm, or compressing main vascular structures, or located in both hemilivers should be considered, as well as complicated cysts, in the category of complex hydatid cysts.In a retrospective study including 55 patients, we evaluated the characteristics of complex hydatid cysts, and compared surgical outcomes between patients operated on for complex cysts (Complex Group) and those operated on for non-complex cysts (non-Complex Group).In the Complex Group, 19% of patients had cysto-biliary communication with recurrent cholangitis, 9.5% had cysts eroding the diaphragm or chest wall, or communicating with the bronchial tree, 31% had cysts with contact with main vascular structures, 11.9% had multiple bilobar cysts, 14.3% had giant cysts with organ displacement, and 14.3% had a combination of the above-mentioned types. Type of surgical treatment was different between the two groups (P < .001). Additional procedures were statistically more frequent in the Complex Group (P = .02). Postoperative morbidity was higher in the Complex Group, although not in a significant manner (P = .07). Median hospital stay was longer in the Complex Group (12 vs 7 days, P < .001). No 30-day mortality occurred. Four patients (7.3%), all belonging to the Complex Group, required reoperation for postoperative complications.Surgery for complex hydatid cysts of the liver is potentially burdened by serious complications. This kind of benign liver disease requires skill-demanding procedures and should be treated in centers with expertise in both hepato-biliary surgery and hydatid disease management.

Echinococcosis is among the most underestimated parasitic diseases that have universal distribution. The primary treatment is surgery. Hence, the development of new and more effective scolicidal agents with lower side effects is crucial. This study evaluated the therapeutic effects of Urtica dioica and Cassia fistula extracts as a scolicidal herbal drug in vitro. Suspension of protoscoleces was obtained from the infected livers of sheep in Khorramabad, Iran. Hydro-alcoholic solution was extracted from the leaves and stems of Urtica dioica and the fruit of Cassia fistula. Echinococcus granulosus protoscoleces were treated with the essential oils at concentrations of 10, 25, 50, and 100 mg/mL for 10, 20, 30, and 60 min and their viability was evaluated by the eosin staining test. The extract of Urtica dioica at a concentration of 100 mg/mL killed 90.51% of protoscoleces after 60 min. Cassia fistula also killed 67.74% of protoscoleces after 60 min. This study obtained satisfactory results. Urtica dioica and Cassia fistula extracts are promising protoscolicides and can be used in the treatment of hydatid cysts and pre-surgically to prevent secondary infections.

Failure to follow the World Health Organization's Informal Working Group on Echinococcosis guidance or having limited experience in the management of cystic echinococcosis (CE) in endemic or nonendemic areas of the world may lead to risky unnecessary procedures.

Medical records of all patients undergoing surgery for hepatic hydatid disease at the gastroenterologic surgery and general surgery departments of our hospital between December 2014 and October 2019 were collected and reviewed retrospectively. Demographic characteristics, the size and number of the cysts preoperative liver function tests, surgical treatment, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage (PD), morbidity, and treatment outcomes were reviewed.

Of 122 patients included in the study, 77 (63, 1%) were female and 45 (36, 9%) were male individuals and their mean age was 44.95 years. CE1 was identified in 13 patients (10.6%) CE2 in 66 patients (54.1%), CE3a in 7 patients (5.8%), CE3b in 28 patients (22.9%), and CE4 in 8 patients (6.6%). Twenty patients (16.4%) with a cystobiliary fistula in the liver, obstructive jaundice, and postoperative bile leak underwent ERCP. PD was performed in patients with fluid in the hepatic hydatid cyst pouch, increased pouch size because of bile collection, and clinical symptoms postoperatively. Patients presenting with persistent bile leak despite PD underwent ERCP and were treated with endoscopic sphincterotomy and stent placement. Patients with PD were followed by keeping the percutaneous drain open and closed for a while to create pressure difference in the cyst pouch after ERCP. The percutaneous drain was removed in the next 14 to 21 days after checking the pouch size, whereas the common bile duct stents were removed 2 months later after performing a follow-up cholangiography.

ERCP should be the primary method for the diagnosis and treatment for hepatic hydatid cysts ruptured into the ducts. İn some cases, high-flow hydatid cysts with rupture into the bile ducts or persistent biliary fistulas can be treated with ERCP and endoscopic sphincterotomy, biliary stent, PD, and nasobiliary drainage without the need for surgical intervention.