In addition to surgical resection (surgical removal), drug and percutaneous (“through the skin“) therapies are also available.
Alveolar Echinococcosis (AE)
Surgical resection is the only curative therapy (therapy that aims to cure the patient)!
In alveolar echinococcosis, an attempt is made to radically remove the finding, i.e., complete surgical resection (R0; removal in healthy tissue) of the affected liver parenchyma and, if affected, the adjacent organs. Resection should be performed en bloc with appropriate lymphadenectomy and adequate safety margin (1 cm).
Another therapy is liver transplantation (LTX) as a potentially curative measure.Perioperative drug therapy with albendazole (anthelmintic/worm drug) is performed. Therapy is continued for at least two years after R0 resection (removal of parasite foci in healthy tissue; histopathology shows no parasite foci in the resection margin).
Cystic echinococcosis (CE)
Therapy of choice is surgical resection.
Indications:
- Resectable and large cysts (>5 cm) in stage CE2-CE3 with multiple daughter cysts.
- Cysts with a high risk of rupture (spontaneous/traumatic) due to their superficial location
- Cysts that press on neighboring organs due to their size and are symptomatic
- Cysts that have invaded the biliary system.
- Superinfected cysts
The procedures
- Laparoscopic resection (surgical removal by laparoscopy).
- Open resection (surgery via an abdominal incision).
- Endocystectomy with omentoplasty (use of the large mesh (omentum majus) to cover/fill the cyst cavity).
- PAIR (Percutaneous Aspiration, Scolicide, Instillation, Re-Aspiration); noninvasive therapeutic procedure in developing countries; contraindication (contraindication): existing cysto-biliary fistulae.
Stage appropriate therapy/therapeutic procedures of CE see below classification.
Perioperatively or periinterventionally, drug therapy with albendazole (anthelmintic / vermifuge) is performed.
