Internal drainage of liver hydatid - concerns and solutions

There are a number of procedures for the surgical management of liver hydatid and controversies still persist regarding the best technique Forty-three patients with hydatid disease of the liver were managed surgically between 1991 and 1998. Internal drainage (Roux-en-Y cysto-jejunostomy) was performed in eight cases of liver hydatid with biliary communications. Internal drainage was associated with a high incidence of the infection of the residual cavity with abscess formation (n=3/8, 38%). In all the three patients the cyst was located in the superior segments of the liver (VII, VIII, IVa). In two of the three patients the cyst was larger than 10 cm. Dependent siting of stoma is a key for the successful outcome of internal drainage in liver hydatid. This procedure is best avoided in large cysts, especially those located in the superior segments and with pericyst calcification.