the appropriate treatment for hydatid cyst of the liver   is determined by several factors such as the patient , the cyst , the therapeutic resources , and the physician . although several therapeutic strategies have proven to be effective for hydatid cyst of liver [ 2 , 3 ] , surgery is still the most common therapy despite its morbidity and mortality . furthermore , a variety of techniques have been recommended for managing the residual cavity after cystectomy [ 511 ] , but none of these methods is universally applicable . we report a modified technique for introflexion of hydatid cyst residual cavity with using overlapping flaps of liver edges ( vest over pant ) . participants were all patients consecutively admitted to the general surgery unit of the study hospital for elective surgery of liver hydatid cyst . in approach to liver hydatid cyst , we perform laparotomy with transverse right subcostal incision . liver mobilization of right hepatic lobe exposing the bare area is performed by dissection of hepatic diaphragmatic attachments . in addition , division of the falciform ligament and peritoneal attachments to the left lateral segment are completed . each liver cyst is aspirated with a needle and cavity is filled with 0.5% agno3 for 10 minutes . cyst fluid is aspirated again and then opened through a vertical incision to evacuate proligerous membrane . the cyst content is evacuated and cavity evaluated for biliary communications . for intramural cyst , we use cystectomy . biliary communications are closed with direct suture . then , the edges of one side of cyst are sutured to the base of the cavity using three to four mattress sutures with chromic 0 designed for liver suturing ( figure 1 ) , and edges of other side of liver are overlapped on the dorsal part of previous layer using four to five mattress sutures ( figures 2 and 3 ) . the clinical findings were abdominal mass in 20 ( 40% ) cases and abdominal pain in 30 cases ( 60% ) . all of the patients had single cyst . in 46 patients , cysts were located in right lobe . the average cyst volume was 423  110  ml ( 300650  ml ) . in two patients , biliary communications were closed by direct sutures . there was no intraabdominal sepsis , bile leakage , or hepatic necrosis . in follow - up ultrasound study hydatid cysts represent the liver stage of the dog tapeworm echinococcus granulosus . the disease is endemic in many countries such as iran . the appropriate treatment of hydatid cyst is determined by several factors and is surgical or percutaneous drainage with intracystically injected scolicidal agents and chemotherapy . many promising surgical techniques have been suggested through the years , but none has proven to be accurate enough , and their clinical relevance has been questioned . cystectomy is considered the least traumatic method for hydatid cysts excision , but there is typically a larger residual cavity that can lead to a number of life - threatening complications such as suppuration , recurrence , and biliary fistula . suture obliteration , omentoplasty , introflexion , double breasting , simple closure , deroofing , and tube drainage [ 511 ] are the most commonly used techniques for residual cavity management . losanoff et al .   discussed various methods of residual cavity management techniques and their limitation . these limitations are inapplicability for extremely large cysts for omentoplasty , injury to blood vessels , and biliary tract in capitonnage , intestinal entrapment in the residual cavity in deroofing , and risk of spillage and anaphylactic shock in percutaneous aspiration under radiologic guidance . losanoff used a variant of capitonnage method by manual compression of the healthy liver parenchyma and approximation of cavity edges with mattress sutures . for filling of dead space cavity , he used omentoplasty or gelatin sponge . in our study by using vest - over - pant method we obliterated the dead space without using of foreign materials or omentum . in this method there was no need for massive mobilization of liver and therefore , there was no additional damage to organ . it seems that this technique is a simple and effective method for residual cavity management in large hydatid cyst .
objective . 
 although several therapeutic strategies have proven to be effective for hydatid cyst of liver , but surgery is still the most common therapy despite its morbidity and mortality . 
 furthermore , a variety of technique has been recommended for managing the residual cavity after cystectomy . 
 we report here a new technical method for the reconstruction of hydatid cyst residual cavity with using overlapping flaps of liver edges ( vest over pant ) . 
 methods . in this technique after removing the cyst , the edges of one side of cyst cavity were sutured to the base of the cavity using three to four mattress sutures ) , and edges of other side of liver was overlapped on the dorsal part of previous layer using four to five mattress sutures . 
 therefore residual cavity dead space was obliterated with two surfaces of cavity . 
 results . 
 fifty males were treated by our method . 
 the average cyst volume was 423  110  ml . there was no intraabdominal sepsis , bile leakage , or hepatic necrosis . in follow - up ultrasound study , residual cavities were disappeared one month after operation . 
 conclusion . 
 overlapping flaps of liver edges ( vest over pant ) provides easy , safe closure of cyst with preservation of the liver anatomy .