Surgical management of a hydatid cyst of the hepatic dome ruptured into the biliary tree

Hydatid disease of the liver remains an important and challenging medical problem. Although surgery is considered the treatment of choice for hydatid disease of the liver, controversies still exist about the preferred operative technique. We report the case of a patient with obstructive jaundice caused by rupture of a hydatid cyst of the hepatic dome into the biliary tract. He was managed by a new surgical approach of myoplasty of the right hemidiaphragm combined with preoperative decompression of the bile duct by an endoscopic sphincterotomy. The postoperative course of the patient was uneventful, and he remains well 3 years later. This procedure is simple, requires less time, and has the advantage of avoiding a thoracoabdominal incision, which makes any abdominal reoperation easier.