#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Surgical management of hepatic echinococcosis – a practical approach and experience from a tertiary center


Authors: J. Draganovič 1,2 ;  J. Zajak 1;  K. Vinklerová 1,3;  P. Gebouský 2,4;  F. Čečka 1,2
Authors‘ workplace: Chirurgická klinika, FN Hradec Králové 1;  Lékařská fakulta UK v Hradci Králové 2;  Univerzita obrany, Brno 3;  Klinika infekčních nemocí, FN Hradec Králové 4
Published in: Rozhl. Chir., 2026, roč. 105, č. 8, s. 397-403.
Category: Original articles
doi: https://doi.org/10.48095/ccrvch2026397

Overview

Hepatic echinococcosis is a rare parasitic disease, with the incidence of the alveolar form increasing in Central Europe in recent years. Cystic and alveolar echinococcosis differ substantially in their biological behavior and management. The aim of this study is to provide an overview of the current literature and to present the experience from a tertiary center with the surgical treatment of this disease. The study combines a review from the literature with a retrospective analysis of patients who underwent surgical treatment at the University Hospital Hradec Králové between January 2022 and February 2025. Six patients were included, five of whom had alveolar echinococcosis. Half of the patients were asymptomatic at the time of diagnosis. The in-hospital course was uncomplicated in all patients; one pulmonary embolism was recorded within the 90-day morbidity period, and 90-day mortality was zero. All patients underwent long-term follow-up in collaboration with the Department of Infectious Diseases. Treatment of cystic echinococcosis follows a stage-specific approach, and depending on the characteristics of the lesion, includes watch-and-wait, albendazole therapy, percutaneous treatment, or surgery. In resectable alveolar echinococcosis, R0 resection followed by long--term albendazole therapy is the treatment of choice, whereas lifelong albendazole therapy is indicated when R0 resection is not feasible; R1 resection is not recommended. Surgical treatment of hepatic echinococcosis in a tertiary center represents a safe and effective treatment option for selected patients, while a multidisciplinary approach and long-term follow-up remain essential.

Keywords:

liver resection – alveolar echinococcosis – Cystectomy – cystic echinococcosis – hepatic echinococcosis


Sources

1. Draganovič J, Zajak J, Vinklerová K et al. Jaterní echinokokóza –⁠ narativní review. Prakt Lék 2025; 105 (5–6): 215–220.

2. Kristianova H, Kolarova L, Krska Zet al. Surgical treatment of alveolar echinococcosis: a single center experience and systematic review of the literature. Rozhl Chir 2019; 98 (4): 167–173. doi: 10.33699/PIS.2019.98.4.167-173.

3. Vuitton DA, McManus DP, Rogan MT et al. International consensus on terminology to be used in the field of echinococcoses. Parasite 2020; 27 : 41. doi: 10.1051/parasite/2020024.

4. Thompson RC. Biology and systematics of echinococcus. Adv Parasitol 2017; 95 : 65–109. doi: 10.1016/bs.apar.2016.07.001.

5. WHO/OIE Manual on echinococcosis in humans and animals. A public health problem of global concern. 2021 [online]. Available from: https: //www.who.int/publications/i/item/929044522X.

6. Ammann RW, Eckert J. Cestodes. Echinococcus. Gastroenterol Clin North Am 1996; 25 (3): 655–689. doi: 10.1016/s0889-8553 (05) 70268-5.

7. Brunetti E, Kern P, Vuitton DA et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114 (1): 1–16. doi: 10.1016/j.actatropica.2009.11.001.

8. WHO Informal Working Group. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 2003; 85 (2): 253–261. doi: 10.1016/s0001-706x (02) 00223-1.

9. Keong B, Wilkie B, Sutherland T et al. Hepatic cystic echinococcosis in Australia: an update on diagnosis and management. ANZ J Surg 2018; 88 (1–2): 26–31. doi: 10.1111/ans.14117.

10. Siles-Lucas MM, Gottstein BB. Molecular tools for the diagnosis of cystic and alveolar echinococcosis. Trop Med Int Health 2001; 6 (6): 463–475. doi: 10.1046/j.1365-3156.2001.00732.x.

11. Touma D, Sersté T, Ntounda R et al. The liver involvement of the hydatid disease: a systematic review designed for the hepato-gastroenterologist. Acta Gastroenterol Belg 2013; 76 (2): 210–218.

12. WHO guidelines for the treatment ofpatients with cystic echinococcosis. 2026 [online]. Available from: https: //www.who.int/publications/i/item/9789240110472.

13. Velasco-Tirado V, Alonso-Sardón M, Lopez-Bernus A et al. Medical treatment of cystic echinococcosis: systematic review and meta-analysis. BMC Infect Dis 2018; 18 (1): 306. doi: 10.1186/s12879-018-3201-y.

14. Lissandrin R, Tamarozzi F, Piccoli L et al. Factors influencing the serological response in hepatic echinococcus granulosus infection. Am J Trop Med Hyg 2016; 94 (1): 166–171. doi: 10.4269/ajtmh.15-0219.

15. Reuter S, Jensen B, Buttenschoen K et al. Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature. J Antimicrob Chemother 2000; 46 (3): 451–456. doi: 10.1093/jac/46.3.451.

16. Piarroux M, Piarroux R, Giorgi R et al. Clinical features and evolution of alveolar echinococcosis in France from 1982 to 2007: results of a survey in 387 patients. J Hepatol 2011; 55 (5): 1025–1033. doi: 10.1016/j.jhep.2011.02.018.

17. Alzoubi M, Daradkeh S, Daradka K et al. The recurrence rate after primary resection of cystic echinococcosis: a meta-analysis and systematic literature review. Asian J Surg 2024: S1015-9584 (24) 02081-5. doi: 10.1016/j.asjsur.2024.09.038

18. Mihmanli M, Idiz UO, Kaya C et al. Current status of diagnosis and treatment of hepatic echinococcosis. World J Hepatol 2016; 8 (28): 1169–1181. doi: 10.4254/wjh.v8.i28.1169.

19. Jahromi KF, Rafiei A, Rahdar M et al. Evaluation of the protoscolicidal effectiveness of hypertonic saline, silver nitrate, ethanol, using sponge pad method and injecting into fertile hydatid cysts. Iran J Parasitol 2022; 17 (2): 223–230. doi: 10.18502/ijpa.v17i2.9540.

20. Moazeni M, Hosseini SV, Al-Qanbar MH et al. In vitro evaluation of the protoscolicidal effect of Eucalyptus globulus essential oil on protoscolices of hydatid cyst compared with hypertonic saline, povidone iodine and silver nitrate. J Visc Surg 2019; 156 (4): 291–295. doi: 10.1016/j.jviscsurg.2019.01.002.

21. Besim H, Karayalçin K, Hamamci O et al. Scolicidal agents in hydatid cyst surgery. HPB Surg 1998; 10 (6): 347–351. doi: 10.1155/1998/78170.

22. Kayaalp C, Balkan M, Aydin C et al. Hypertonic saline in hydatid disease. World J Surg 2001; 25 (8): 975–979. doi: 10.1007/s00268-001-0065-9.

23. Ramia JM, Serrablo A, Serradilla M et al. Major hepatectomies in liver cystic echinococcosis: a bi-centric experience. Retrospective cohort study. Int J Surg 2018; 54 (Pt A): 182–186. doi: 10.1016/j.ijsu.2018.04.049.

24. He YB, Yao G, Tuxun T et al. Efficacy of radical and conservative surgery for hepatic cystic echinococcosis: a meta--analysis. Int J Clin Exp Med 2015; 8 (5): 7039–7048.

25. Kadry Z, Renner EC, Bachmann LM et al. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg 2005; 92 (9): 1110–1116. doi: 10.1002/bjs.4998.

26. Hillenbrand A, Gruener B, Kratzer W et al. Impact of safe distance on long--term outcome after surgical therapy of alveolar echinococcosis. World J Surg 2017; 41 (4): 1012–1018. doi: 10.1007/s00268-016-3813-6.

27. Barth TF, Herrmann TS, Tappe Det al. Sensitive and specific immunohistochemical diagnosis of human alveolar echinococcosis with the monoclonal antibody Em2G11. PLoS Negl Trop Dis 2012; 6 (10): e1877. doi: 10.1371/journal.pntd.0001877.

28. Ambregna S, Koch S, Sulz MC et al. A European survey of perendoscopic treatment of biliary complications in patients with alveolar echinococcosis. Expert Rev Anti Infect Ther 2017; 15 (1): 79–88. doi: 10.1080/14787210.2017.1252260.

29. Koch S, Bresson-Hadni S, Miguet JP et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation 2003; 75 (6): 856–863. doi: 10.1097/01.TP.0000054230.63568.79.

30. Vávra P, Třeška V, Ostruszka P et al. Chirurgické řešení komplikované jaterní echinokokózy u dvou bulharských občanů na dvou pracovištích v České republice. Rozhl Chir 2012; 91 (7): 381–387.

Labels
Surgery Orthopaedics Trauma surgery

Article was published in

Perspectives in Surgery

Issue 8

2026 Issue 8
Popular this week
Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#