Secondary Cystic Echinococcosis in South of Iran: A Retrospective Study

Abstract

Background: Cystic echinococcosis (CE) is a parasitic and zoonotic infection, recognized globally as aneglected disease, with significant morbidity and mortality rates, especially in low-advantaged countries. Weaimed to evaluate the recurrence rate after hydatid disease surgery in Fars Province, Iran.Methods: A retrospective design was used to examine the data collected from Nemazee and Shahid FaghihiHospitals, Shiraz, southern Iran, over eight years, from 2011 to 2019. The research was conducted in 2023.The study extracted the following data from hospital records: demographic characteristics, paraclinicalfindings (such as sonography and CT scan), organ involvement, cyst number and size, surgical procedure, cystcomplications, intraoperative or postoperative complications, and recurrence rate.Results: The study included 303 patients, of whom recurrence occurred in 36 (11.9%). Intra or postoperativecomplications were associated with recurrence (P=0.001). In the recurrent cases, the most common intraoperativecomplication was anaphylactic shock (P=0.001), and the most common postoperative complicationswere unresolved pneumothorax and empyema (P=0.001). There was a significant association betweenrecurrence and complicated cysts (P=0.001). There was no significant difference between the organ involvedand the complicated cyst in the recurrence (P=0.50). There was no association between increasing the cyst’ssize and the chance of the recurrence rate. There was a significant relationship between recurrence and thenumber of cysts in the affected organ (P=0.001). There was a significant association between using no scolicidalagents and recurrence (P=0.001), and no antiparasitic drugs were used in only one (2.7%) patient (P=0.3240).There was no significant association between recurrence and duration of admission (P=0.193).Conclusion: Intra or postoperative complications (anaphylactic shock, unresolved pneumothorax, andempyema), complicated cysts, the number of cysts in the affected organ, and injecting of no scolicidal agentswere significantly associated with recurrence. Recurrence may have many reasons, such as insufficient drainage(incomplete peri-cystectomy and minute spillage of cyst contents), missing hidden cysts (numbered cysts),rupture or spillage of the cysts, and inadequate medical treatment.

Keywords

• echinococcosis
• recurrence
• intraoperative complications
• postoperative complications
• scolicidal agents