Abstract Background Comparative evidence on laparoscopic versus open surgery for hepatic hydatid-cyst disease in endemic regions remains limited. Methods We reviewed records of 43 consecutive patients who underwent surgery for liver hydatid cysts at two tertiary hospitals in Khorramabad, Iran. Twenty-two patients had laparoscopic cyst evacuation and 21 had open surgery. Primary outcomes were postoperative complications, including surgical-site infection (SSI), bile leakage, and 1-year recurrence, while secondary outcomes were operative time, postoperative pain (Numeric Rating Scale, NRS), and length of hospital stay (LOS). Results Baseline demographics were comparable between groups. Laparoscopy yielded significantly less intra-operative blood loss (all cases < 100 mL vs 71% in the open cohort; p = 0.009), fewer bile leaks (0% vs 19%; p = 0.048), and a lower SSI rate (4.5% vs 28.6%; p = 0.046). Mean operative time was halved (29 ± 2.9 min vs 63.8 ± 7.7 min; p < 0.001), postoperative pain scores were lower (NRS 3.4 ± 0.7 vs 7.2 ± 1.1; p < 0.001), and LOS was shorter (2.6 ± 0.5 vs 5.2 ± 0.7 days; p < 0.001). Local recurrence (0% vs 14.3%; p = 0.108) and 1-year overall recurrence (4.5% vs 9.5%; p = 0.607) did not differ significantly, and there were no deaths. Conclusions In this endemic-region cohort, laparoscopic management of hepatic hydatid cysts was associated with markedly fewer peri-operative complications, faster recovery, and no increase in short-term recurrence compared with open surgery. Whenever adequate expertise and equipment are available, laparoscopy should be considered the preferred first-line approach; larger multi-center trials are warranted to confirm these findings.
Rahnamei et al. (2026) studied this question.