Diaphragm myoplasty in the prevention of complications after surgery of hydatid disease of the liver

A variety of techniques have been used for surgical treatment of hepatic hydatid cysts. The objective of this study is to describe the technique of diaphragm myoplasty, and to present our experience in the treatment of selected patients with hydatid disease of the liver by means of this alternative surgical technique. The technique combines a diaphragm myoplasty with a wide partial cystectomy performed through a right thoraco-phrenotomy incision. The medical records of the patients with hydatid disease of the liver who were submitted to surgical treatment with this technique were reviewed. The clinical manifestations, laboratory examinations, operative notes, and postoperative results were analyzed. Eight consecutive patients with hepatic hydatid cyst were operated on. The cyst was located in the posterior-superior aspect of the right hepatic lobe in all patients. Five patients suffered from recurrence of a previously operated hepatic hydatid cyst, and two patients suffered from complications of their disease. There was no in-hospital mortality or morbidity. The early and late postoperative results compare favorably with the results of other investigators. The alternative surgical technique for treatment of selected patients with hepatic hydatid disease is indicated for patients with a cyst located in the posterior-superior aspect of the right hepatic lobe, especially if there is a recurrence of the disease after a previous surgery or involvement of the diaphragm and/or the intrathoracic organs. The technique provides easy and safe access to the cyst and carries most of the advantages of omen-toplasty.