ORIGINAL ARTICLE
Open Access

Surgical Management of Liver Hydatid Disease: Laparoscopic Versus Open Approach

James T. Marshall1, Emily K. Foster, Richard J. HamiltonORCID 1

1Department of Hepatobiliary and Minimally Invasive Surgery King’s College Hospital NHS Foundation Trust, London, United Kingdom.

DOI: https://doi.org/10.18081/ajbm/2025.3/214Crossmark logo

 Received 20 May 2025, Revised 03 June 2025, Accepted 14 July 2025, Available online 10 August 2025
© 2025 Hamilton, et al. This is an open-access article under a Creative Commons license (CC BY 4.0).
CC BY 4.0

ABSTRACT

Background

Hepatic hydatid disease caused by Echinococcus granulosus remains a significant surgical challenge worldwide, especially in endemic regions. Although open surgery has been the traditional standard for definitive management, advances in minimally invasive hepatobiliary techniques have introduced laparoscopic procedures as a safer, less morbid alternative. Despite this evolution, concerns persist regarding intraoperative spillage, anaphylaxis, and long-term recurrence, particularly in complex cysts.

Objective

To compare the operative safety, postoperative outcomes, and recurrence rates between laparoscopic and open surgical management of hepatic hydatid cysts, using standardized patient selection based on the World Health Organization–Informal Working Group on Echinococcosis (WHO-IWGE) classification.
Methods

This prospective comparative study was conducted at the Department of Hepatobiliary and Minimally Invasive Surgery, King’s College Hospital, London, between January 2022 and December 2024. Sixty patients with radiologically confirmed hepatic hydatid cysts (WHO-IWGE types CE1–CE3a) were enrolled and assigned to either laparoscopic (n = 30) or open (n = 30) surgery. All procedures followed standardized scolicidal precautions using 20% hypertonic saline and closed suction systems. Postoperative morbidity, pain (VAS at 24h), hospital stay, and recurrence (12-month follow-up) were compared using t-test and Chi-square analysis (P < 0.05).

Results

Baseline demographics and cyst characteristics were comparable between groups.
Laparoscopic surgery resulted in significantly lower blood loss (110 ± 40 mL vs. 210 ± 60 mL; P < 0.001), reduced postoperative pain (VAS 3.2 ± 1.1 vs. 6.1 ± 1.3; P < 0.001), and shorter hospital stay (3.1 ± 0.9 vs. 7.2 ± 1.6 days; P < 0.001). Wound infection occurred in 3.3% of laparoscopic cases versus 20% in open cases (P = 0.048). Recurrence rates at 12 months were low and statistically similar (3.3% vs. 6.7%; P = 0.55). No mortality or major bile duct injury occurred. Multivariate regression identified open surgery (OR 3.14, 95% CI 1.08–9.12; P = 0.035) and cyst size >8 cm (OR 2.86, P = 0.047) as independent predictors of postoperative morbidity.

Conclusion

Laparoscopic management of hepatic hydatid cysts is a safe, effective, and patient-centered alternative to open surgery for WHO-IWGE stage CE1–CE3a cysts. It offers clear advantages in reduced morbidity, faster recovery, and comparable recurrence control when performed under strict anti-spillage precautions by experienced hepatobiliary surgeons. Integration of WHO-based staging, standardized scolicidal protocols, and structured laparoscopic training is recommended to optimize outcomes and broaden access to minimally invasive hydatid surgery across both endemic and non-endemic regions.

Keywords: Hydatid cyst; Echinococcus granulosus; Laparoscopic cholecystectomy; Hepatic surgery

Cite this article

Marshall JT, Foster EK, Hamilton RJ. Surgical Management of Liver Hydatid Disease: Laparoscopic Versus Open Approach. Advanced Journal of Biomedicine & Medicine. 2025;13(3):214-231. doi:10.18081/ajbm/2025.3/197

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Cite this article

James T. Marshall, Emily K. Foster, Richard J. Hamilton (2025). Surgical Management of Liver Hydatid Disease: Laparoscopic Versus Open Approach. American Journal of Biomedicine, 13(3), 214-2131. https://doi.org/ 10. 10.18081/ajbm/2025.3/214
James T. Marshall, Emily K. Foster, Richard J. Hamilton. "Surgical Management of Liver Hydatid Disease: Laparoscopic Versus Open Approach." American Journal of Biomedicine, vol. 13, no. 3, 2025, pp. 214-2131. DOI: 10. 10.18081/ajbm/2025.3/214.
James T. Marshall, Emily K. Foster, Richard J. Hamilton. Surgical Management of Liver Hydatid Disease: Laparoscopic Versus Open Approach. Am J Biomed. 2025;13(3):214-2131. DOI: 10. 10.18081/ajbm/2025.3/214. PMID: .
James T. Marshall, Emily K. Foster, Richard J. Hamilton 2025, "Surgical Management of Liver Hydatid Disease: Laparoscopic Versus Open Approach", American Journal of Biomedicine, vol. 13, no. 3, pp. 214-2131.
@article{james2025, title={Surgical Management of Liver Hydatid Disease: Laparoscopic Versus Open Approach}, author={James T. Marshall, Emily K. Foster, Richard J. Hamilton}, journal={American Journal of Biomedicine}, volume={13}, number={3}, pages={214-2131}, year={2025}, doi={ 10. 10.18081/ajbm/2025.3/214} }
TY - JOUR AU - James T. Marshall, Emily K. Foster, Richard J. Hamilton TI - Surgical Management of Liver Hydatid Disease: Laparoscopic Versus Open Approach JO - American Journal of Biomedicine VL - 13 IS - 3 SP - 214-2131 PY - 2025 DO - 10. 10.18081/ajbm/2025.3/214 ER -
%0 Journal Article %A James T. Marshall, Emily K. Foster, Richard J. Hamilton %T Surgical Management of Liver Hydatid Disease: Laparoscopic Versus Open Approach %J American Journal of Biomedicine %V 13 %N 3 %P 214-2131 %D 2025 %R 10. 10.18081/ajbm/2025.3/214 %M
James T. Marshall, Emily K. Foster, Richard J. Hamilton (2025). Surgical Management of Liver Hydatid Disease: Laparoscopic Versus Open Approach. American Journal of Biomedicine, 13(3), 214-2131. https://doi.org/ 10. 10.18081/ajbm/2025.3/214

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