Management of hepatic echinococcosis: Should surgical intervention be the first-line therapeutic option?

Introduction. Echinococcosis is a serious zoonotic disease, especially in endemic regions. Its treatment remainsthe subject of debate,, including pharmacotherapy, percutaneous techniques, and surgery. Without intervention, mortality can reach 90%. Common symptoms include weight loss, right upper quadrant discomfort, and, less frequently, jaundice with cholangitis. Materials and methods. This unsystematic literature review covers studies from PubMed and Google Scholar (2020-2025) focused on echinococcosis treatment. Keywords included: echinococcosis, treatment outcomes, diagnostic methods, surgery, cystic echinococcosis (CE). Results. Thechoice of therapy depends of thedisease stage. The most effective strategy is radical surgical resection combined with benzimidazole-based therapy, which has a low recurrence rate. However, surgery carries risks such as bleeding, bile leakage, infections, and bowel obstruction. Despite these complications, it remains the gold standard, offering favorable long-term results. In cases with hydatid cyst abscess, non-radical surgery is preferred to reduce postoperative complications. Albendazole monotherapy is suitable only for lesions under 5 cm, extending 10-year survival in 80% of cases. Due to the long latency and nonspecific early symptoms, surgery is required in most cases. Conclusions. Pharmacotherapy alone is rarely sufficient. Surgery remains the most effective approach, ensuring parasite removal and lowering recurrence risk. The best outcomes are achieved with a combined approach: initial albendazole therapy, followed by surgery after cyst shrinkage, and continued albendazole use postoperatively.