Wagner T, Struck S, Persigehl T, Nierhoff D, Schmidt T, Hummels M, Bruns CJ, Stippel DL, Thomas MN. Long-term outcomes after open total pericystectomy for cystic echinococcosis. World J Gastrointest Surg 2025; 17(9): 106258 [DOI: 10.4240/wjgs.v17.i9.106258]
Corresponding Author of This Article
Tristan Wagner, Department of General, Visceral, Thoracic and Transplantsurgery, University of Cologne, Kerpener Street 62, Cologne 50923, North Rhine-Westphalia, Germany. tristan.wagner@uk-koeln.de
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2025; 17(9): 106258 Published online Sep 27, 2025. doi: 10.4240/wjgs.v17.i9.106258
Long-term outcomes after open total pericystectomy for cystic echinococcosis
Tristan Wagner, Sebastian Struck, Thorsten Persigehl, Dirk Nierhoff, Thomas Schmidt, Marielle Hummels, Christiane J Bruns, Dirk L Stippel, Michael N Thomas
Tristan Wagner, Sebastian Struck, Thomas Schmidt, Marielle Hummels, Christiane J Bruns, Dirk L Stippel, Michael N Thomas, Department of General, Visceral, Thoracic and Transplantsurgery, University of Cologne, Cologne 50923, North Rhine-Westphalia, Germany
Thorsten Persigehl, Department of Diagnostic and Interventional Radiology, University of Cologne, Cologne 50923, North Rhine-Westphalia, Germany
Thorsten Persigehl, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne 50923, North Rhine-Westphalia, Germany
Dirk Nierhoff, Department of Gastroenterology and Hepatology, University of Cologne, Cologne 50923, North Rhine-Westphalia, Germany
Co-corresponding authors: Tristan Wagner and Michael N Thomas.
Author contributions: Wagner T and Thomas MN designed the study; Struck S, Thomas MN, Schmidt T, Stippel DL were responsible for developing the methodology; Persigehl T, Hummels M, Wagner T, Nierhoff D, Bruns CJ participated in the formal analysis and investigation; Wagner T and Struck S wrote the draft; Wagner T, Schmidt T, Thomas MN, Stippel DL participated in the review and editing.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the University of Cologne (23-1371-retro).
Informed consent statement: Signed informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tristan Wagner, Department of General, Visceral, Thoracic and Transplantsurgery, University of Cologne, Kerpener Street 62, Cologne 50923, North Rhine-Westphalia, Germany. tristan.wagner@uk-koeln.de
Received: February 24, 2025 Revised: April 13, 2025 Accepted: August 1, 2025 Published online: September 27, 2025 Processing time: 216 Days and 13.6 Hours
Abstract
BACKGROUND
Liver hydatid cysts (LHC) liver requires effective surgical treatment. Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.
AIM
To evaluate the outcomes of pericystectomy and its efficacy as a treatment modality for cystic echinococcosis (CE).
METHODS
Thirty-eight patients were analyzed after open total pericystectomy at the University Hospital of Cologne between January 2006 and January 2024. Demographic, clinical, and laboratory parameters were collected retrospectively. Intraoperative data and postoperative complications were documented and classified using the Clavien-Dindo classification. Throughout the follow-up period, patients underwent regular clinical, serological, and sonographic evaluations both at the outpatient department and by their general physicians.
RESULTS
Fifty-four cysts were treated with open total pericystectomy. Multiple cysts were found in 42.2% of cases. Singular cysts occurred in 57.8%. The right hepatic lobe was affected in 66.7%. Ectopic cysts occurred in 4 patients in the lung (n = 3) and spleen (n = 1). Median cyst size was 6.78 cm × 5.92 cm (range: 1.4-20.0 cm). The median surgical time of pericystectomy was 189 minutes (range: 78-455 minutes) with a median blood loss of 400 mL (range: 100-1400 mL). The complication rate (Clavien-Dindo > III) was 21.1%. The average hospital stay was 12.5 days. No recurrent disease could be detected after a median follow-up time of 97 months (range: 4-216 months). No recurrent cyst manifestation, postoperative liver failure or death was observed.
CONCLUSION
The presented surgical procedure known as open total pericystectomy is a safe surgical technique in treatment of cystic echinococcosis.
Core Tip: This study presents the largest cohort of standardized open total pericystectomies for cystic echinococcosis, demonstrating its effectiveness in achieving complete cyst removal while preserving liver tissue. Total pericystectomy has evolved as a superior surgical approach, showing significantly lower recurrence rates compared to conservative techniques. Despite concerns about bile leakage and cholestasis, our cohort experienced a low incidence of postoperative bile leakage. With a median 8-year follow-up, the recurrence rate was 0%, highlighting the procedure’s efficacy even in multiple cyst cases. These findings support total pericystectomy as a reliable and durable treatment option for hepatic cystic echinococcosis.
