Hydatid
liver disease in children is a serious problem where the parasite is endemic. Although surgery is considered the treatment of choice, medical
therapy is an alternative, but its curative efficacy is controversial. The aims of this study were to evaluate the curative efficacy of medical treatment and compare the results of surgical techniques with respect to postoperative complications in 102 consecutive children (64 male and 38 female, aged 4 to 15 years, mean 8.15 years) treated in two children's hospitals between 1988 and 1997. In 67, medication with
albendazole was used as the initial
therapy; 17 had multiple hepatic
cysts and 8 had coexisting
cysts in the lung. Success was defined as progressive shrinkage and solidification of the
cyst. The overall success of medical
therapy was approximately 27%: 18 of the 67 patients were cured with
albendazole (15 had a single
cyst, 3 multiple
cysts) and 1 recurrence (6%) was observed. Age, sex, and the size, location, and number of
cysts did not show any relationship to the response to medical
therapy. After 12 to 14 weeks of medical treatment, a viable
cyst on ultrasonography and/or computed tomography was accepted as a sign of treatment failure and these patients were scheduled for surgery. A total of 84 patients (35 primarily, 49 after unsuccessful medical
therapy) were treated surgically. Procedures included
cystectomy and tube drainage in 11 patients,
cystectomy in 17,
cystectomy and capitonnage in 24, and
cystectomy and omentoplasty in 32. The incidence of early postoperative complications was 55% for tube drainage, 18% for
cystectomy, 13% for capitonnage, and 0% for omentoplasty. During the follow-up period, 2 surgical patients (2%) developed recurrent disease. Medical treatment with
albendazole resulted in fewer curative successes than expected. A longer period of medical treatment may increase the success rate; this question requires further study. Omentoplasty decreased the rate of early postoperative complications, especially cavity
abscess and
biliary fistula, after surgical treatment and should be recommended in this setting.