Predictive factors of recurrence after surgical treatment for liver hydatid cyst.

BACKGROUND: Hydatid recurrence after surgery is about 10 %. It still constitutes a problem both in terms of pathophysiology and management of recurrence. AIM: The aim of this study was to assess the management of abdominal hydatid recurrence after surgical treatment for liver hydatid cyst and to identify the predictive factors of recurrence. METHODS: We retrospectively included all the patients operated on between January 1, 2008, and December 31, 2012, in the Department "B" of Charles Nicolle Hospital (Tunisia), for abdominal hydatid recurrence. Sixteen men and 33 women, with a median age of 45 years, were included. For all patients, clinical variables and morphological and intra-operative characteristics concerning both the hydatid cysts previously treated and the recurrent cysts were collected. Surgical procedures were recorded as well as the immediate and long-term outcomes. Comparative studies were performed: "extrahepatic recurrence versus No," "peritoneal recurrence versus No," and "open approach versus laparoscopic approach." A univariate analysis followed by a multivariate analysis was carried out to determine predictive factors of hydatid recurrence. RESULTS: Comparative analysis showed that laparoscopic approach, segments II and III localization, and postoperative complications during the first intervention were associated with a greater number of both peritoneal and extrahepatic hydatid recurrence. Multivariate analysis retained the laparoscopic approach as a predictive factor of both peritoneal recurrence (OR 5.5; 95 % CI 1.56; p = 0.008) and abdominal extrahepatic recurrence (OR 3.54; 95 % CI 1.08; p = 0.035). CONCLUSION: Laparoscopic approach for the treatment of liver hydatid cysts was associated with a higher rate of extrahepatic and peritoneal recurrence than open.