**5. Follow-up**

*Overview on Echinococcosis*

tests and leukocyte counts [17].

**4.2 Percutaneous treatment**

biliary tract [5].

treatment.

**4.3 Surgical treatment**

cavity management [18].

using open or laparoscopic surgery [19].

omentoplasty, or external drainage.

cure definitively the patient [18].

contents and pericystic tissue.

has high morbidity and recurrence rates [19].

open or closed pericystectomy, and hepatic resection.

of blood loss but lower cystic recurrence rates.

the outer cystic layer may limit the liver parenchyma damage.

The watch and wait strategy is a therapeutic option for uncomplicated cysts with multiple involvements. It requires a regular long-term monitoring of liver function

The percutaneous treatment modality is defined as an option for the management of cysts in the liver and other abdominal locations. This procedure is divided into two techniques: (1) PAIR technique is the best known, consisting of the destruction of the germinal membrane following the use of a scolicidal agent and (2) modified catheterization techniques aiming at the entire endocyst evacuation. This approach is a mini invasive procedure comparing to the surgery, but cysts containing daughter vesicles are not the best indication for percutaneous treatment because of the high risk of spread into the peritoneal cavity and into the

Surgery should be carefully evaluated. The decision-making is based on the characteristics of the hydatid cyst as the cyst type, number, size, location, and the presence or not of associated complications. It is well recommended for large cysts containing multiple daughter vesicles, symptomatic and complicated cysts, cysts with superficial location that may be ruptured spontaneously or following a benign trauma, infected cysts and cysts with close contact with vessels or adjacent vital organs. Furthermore, it can be an option for patients not suitable for percutaneous

The surgical approach is aiming to parasite inactivation, evacuation of the endocyst with the prevention of contamination, germinal layer removal, and residual

Regarding the abdominal sites (typically the hepatic involvement), there are two surgical approaches consisting of a conservative surgery and radical procedure

Conservative procedures consist of the parasitic cyst contents removal such as daughter vesicles and germinative membrane, whereas the pericyst is retained. The residual cavity is carefully explored to research any evidence of cystic biliary tract communication and then managed according to different techniques: capitonnage,

Surgeons should cover the operating field with a scolicidal agent in order to

Conservative surgery is simple, safe with relatively reduced operative time, but

Radical surgery is the first therapeutic choice suitable for total excision of the entire parasitic lesion. Whenever possible, complete resection is required because radical surgical procedures are superior to conservative surgical methods and may

The radical surgery target is the removal of the whole cyst with the parasitic

Radical procedures includes: partial cystectomy, total cystic removal through an

During the pericystectomy, a proper cleavage plane between the inner layer and

Hepatic resection is more difficult, takes longer operative time with higher risk

avoid the parasites spillage and the peritoneal cavity contamination.

**6**

A long-term follow-up for patients managed for hydatid disease should be planned because recurrences may occur in some cases. The patient monitoring is mainly based on imaging techniques (US, CT, and MRI) at short intervals. Serological tools and specific serum antibodies dosage support imaging techniques and can reflect metastode viability. Moreover, the monitoring of parasitostatic plasma level is necessary to adjust the therapeutic range and to prevent long-term treatment side effects [20].

Currently, planning for the echinococcosis control relies on the interruption of parasitic life cycle. The disease can be prevented by hygiene improvement in the slaughtering of livestock, public education campaigns, periodic deworming of dogs, and adequate destruction of infected offal. Vaccination of dogs with recombinant proteins provides encouraging prospects for prevention and control [21].
