The evidence based data of hydatid
liver disease indicate that the level of evidence was too low to help decide between radical or conservative surgeries (level IV evidence, grade C recommendation). So, there is a need for accurately designed randomized trials with precise goals to compare pericystectomy versus a specific modified endocystectomy technique for the treatment of
hepatic hydatid cysts 8 cm or less in diameter in Egyptian patients, regarding the
operative time, intra-operative blood loss, complications and long-term recurrence and to test the role of anti-hydatid
IgG4 in diagnosis and detection of early recurrence. 60 patients with 131 liver
cysts of E. granulosus fulfilling the study criteria were randomly divided to two groups. GI: 32 patients with 69
cysts treated by modified endocystectomy and GII: 28 patients with 62
cysts treated by closed total pericystectomy. GIa included 40
cysts >5 cm in diameter (mean 6.86, SD+/-0.809) & GIb 29
cysts < or = 5 cm in diameter (mean 4.17 SD+/-0.83). GIIa included 37
cysts >5 cm in diameter (mean 7.01 SD+/+0.79) & GIIb 25
cysts < or = 5 cm in diameter (mean 4.04 SD+/-0.93). Preoperative evaluation included history taking, clinical examination, blood tests, specific anti-hydatid
IgG4, abdominal sonography and CT scan. The
operative time for dealing with each
cyst was in minutes. Operative blood loss and need for
blood transfusion were estimated for each patient. Specific anti-hydatid
IgG4 by ELISA was used to diagnose and to detect early recurrence. Patients were followed up clinically and by ultrasonography every 3 months and for anti-hydatid
IgG4 every 6 months for 24-90 months. The mean maximum
operative time was in GIIa followed by GIa, GIb, then GIIb. The
operative time was significantly lower in GIIb than Ib and in GIa than IIa. Seven patients (GII) had
blood transfusion. The intraoperative
bleeding in GI was <500 ml/ patient, and 18 patients (GII) each bled >500 ml. No intraperitoneal seedling during the follow up. 5 of 55 patients (9%) were serologically suspected of relapse or incomplete cure. One (GII) showed early recurrence at 3 months. High
IgG4 antibodies were detected in patients which decreased gradually after surgery and normal after 18 months post-operation.