**6.4 Hepatic resection**

Sometimes it is necessary to carry out liver resections, e.g., when there are hydatid recurrences in the same lobe previously operated or in residual cavities, which have the risk of subsequent infection with development of liver abscesses and cholangitis. When the infection is controlled by antibiotic therapy or percutaneous drainages, it is recommended to resect the compromised lobe, which is usually more atrophic. This surgery will be consequently more laborious. Nevertheless, the compensatory hypertrophy of the unaffected lobe determines a lower risk of postoperative hepatic failure. With the aim of completely eradicating the parasite and preventing recurrence, several surgical centers perform hepatic resection more frequently by both open and laparoscopic surgeries with acceptable morbidity and very low mortality. Liver resection is more indicated in alveolar echinococcosis by higher frequency of recurrence and infiltrative behavior similar to malignant neoplasms. There are recent reports of liver transplantation and also ex vivo resection surgery with autotransplantation for this type of echinococcosis [54]. Summarizing, hepatic resection, not very used in the past, now appears as a viable alternative for selected cases carried out in specialized reference centers.

The morbidity of resective surgery depends on the complexity of the hydatidosis and the magnitude of the surgery performed. Among the most difficult to treat are biliary fistulas, bleeding, and infections. For example, for patients with fistulization of the cyst toward the bile duct and thorax, it is advisable to work in stages, e.g., treating cholangitis first, and then, when the patient is stabilized, a pleural empyema is drained. Once general conditions have been recovered, the resective surgery is indicated. In relation to morbidity and mortality rates, what has been reported so far shows a great disparity of figures. A surgeon from our university conducted a

study of the risk factors that determine the postoperative morbidity in a significant number of international publications. The results indicate a fairly low level of evidence [55]. The challenge is to perform a prospective series, to achieve consensus on the indications of surgery to treat this complex disease.
