The most common techniques for liver hydatid disease treatment are marsupialization, partial cystopericystectomy with resection of the pericyst and subtotal pericystectomy by peeling the pericystium. The traditional surgical ablation of the cysts is still used by many surgeons all over the world, although the recurrence rate of this procedure is high and ranges from 10 to 30% [2, 4–6].
Marsupialization was the most common used procedure because it is quick and safe, although is accompanied by a high rate of postoperative complications like residual cavity, disease soilage in biliary tract or intraperitoneal, bile leaking, vessels injuries and hemorrhage, sepsis, cholangiitis and allergic shock [2, 6]. For those reasons several technical improvements have been proposed, such as closing of all external communications of the cyst, and obliterating the remaining cyst with omentum or muscle flaps .
In Partial Cystopericystectomy not only the parasitic foci is eliminated but also the surrounded pericyst is removed. In this technique as in subtotal pericystectomy, small pericystic areas, which are located close to vascular and biliary vessels, are not resected because of the high risk for severe complications .
Finally in radical operations the parasitic content and the entire pericystic membrane is removed. In this subcategory the main procedures are total pericystectomy and liver resection. These operations are accompanied by increased morbidity and mortality .
All of the techniques applied in liver echinococcosis surgery present minor or major disadvantages and various postoperative complications. The method we propose is easy to perform, quick, safe and avoids most of the major postoperative complications, while eradicating the disease [10–12]. Although several authors suggest capitonage of the remaining cyst cavity, we avoid it because of the high incidence of postoperative necrosis of the omentum and the development of septic complications . Soiling and peritoneal contamination can be avoided with the simple prophylactic measures that every surgeon must apply in hydatid cyst surgery.
Some other authors suggest introflexion of the cyst. Our technique is a modified combination of capitonage and introflexion. It is well known that these techniques can be used without omentum. We propose a new alternative technique with good results, and it is easy to perform it. In cases that are complicated with postoperative bile leakage the "rosette-like" modified capitonage may facilitate the drainage easier than the "snail-like" introflexion. The results of the classic type of introflexion seem to be similar to ours, although the number of our patients is too small to allow comparison [13, 14].