Surgical Treatment of Liver Echinococcosis — the Role of Laparoscopy

Background: The surgical approach to liver echinococcosis is still a controversial issue. This study shows our results of surgical treatment of liver hydatid cysts during a 5-year period.

Methods: A prospective study of 21 patients operated on in a 5-year period (1999–2003), in Dubrava University Hospital in Zagreb, Croatia, with hepatic hydatid cyst. All patients were pre-operatively treated with albendazole. In 12 patients, total pericystectomy without opening the cyst cavity was performed, 9 open and 3 laparoscopic. In the other 9 patients, partial pericystectomy was done, 6 open and 3 laparoscopic.

Results: There was no mortality after 5–65 months follow-up, but in 1 patient, in the open partial pericystectomy group, recurrence of the disease occurred after 3 years. When a laparoscopic procedure was done, there were no complications or recurrence. The median operative duration for open surgery was 100.0 min (range 60.0-210.0), and for laparoscopic surgery 67.5 min (range 60.0-120.0). The median length of hospitalisation for open surgery was 8.0 days (range 7.014.0), and for laparoscopic surgery 5.0 days (range 4.0-7.0).

Conclusion: Total pericystectomy without opening the cyst cavity, preceded by pre-operative albendazole therapy is the method of choice for hepatic hydatid cyst treatment. Despite the small group of patients, our first results show laparo-scopic total pericystectomy without opening the cyst cavity, in the treatment of hepatic hydatid cyst, as a good alternative to open surgery in selected patients.     

Risk for laparoscopic fenestration of liver cysts

Background: Laparoscopic fenestration is considered the best treatment for symptomatic simple liver cysts. Conversely, the laparoscopic approach for the management of hydatid simple liver cysts is not widely accepted because of the risk for severe complications. Despite improvement in imaging techniques, the probability of preoperatively mistaking a hydatid liver cyst for a simple liver cyst remains about 5%. Therefore, laparoscopic fenestration, planned for a liver cyst could be performed unintentionally for an undiagnosed hydatid liver cyst. Methods: From January 2000 to January 2001, 15 patients with a diagnosis of liver cyst underwent laparoscopy for fenestration. In all cases preoperative serologic and imaging assessment had excluded hydatid liver cyst. To further exclude hydatid liver cyst, preliminary aspiration of the cyst with assessment of cystic fluid characteristics was performed. Results: In two patients with presumedly simple liver cyst, hydatid liver cyst was diagnosed instead at laparoscopy by aspiration of cystic fluid. The procedure was converted to laparotomy with subtotal pericystectomy. Conclusions: The risk of misdiagnosing a hydatid liver cyst for a simple liver cyst, especially in the presence of a solitary cyst, should be considered before laparoscopic fenestration is performed. Intraoperative aspiration of cyst fluid before fenestration can minimize this risk, thus avoiding severe intraoperative and late complications.     

Laparoscopic pericystectomy of liver hydatid cyst

The following report describes a patient with a hydatid cyst located in segment V of the liver which was managed by laparoscopic pericystectomy performed in combination with cholecystectomy. Small hydatid cysts can be removed by the laparoscopic technique; meticulous resection, without opening the cyst, is involved. Compared to the classical approach by laparotomy, this method is less traumatic for the patient, it requires a shorter hospital stay, and it is followed by faster recovery.     

Totally laparoscopic pericystectomy in hepatic hydatid disease

Hepatic hydatid disease is still a commonly seen problem in endemic areas as well as in our country. There is a wide spectrum of therapeutic modalities ranging from simple medical treatment to radical liver resection. Progress in laparoscopic procedures made it possible to consider laparoscopic approaches in selected patients with hepatic hydatid disease. The current laparoscopic approach seems to be limited to cystotomy and drainage. There are fewer reports on hepatic resections or pericystectomy in the literature. In this article we present a case of laparoscopic pericystectomy performed in a selected patient.     

Feasibility and safety of laparoscopic management of hydatid disease of the liver.

BACKGROUND AND OBJECTIVES: Laparoscopic treatment of hydatid disease of the liver produces encouraging results, though its feasibility and safety have been questioned. We evaluated the feasibility and safety of laparoscopic management of hydatid disease of the liver. METHODS: Consecutive patients with this disease reporting to our department from August 1998 to January 2002 were offered laparoscopic management. Our protocol included preoperative albendazole for 4 weeks, laparoscopic cyst evacuation after its sterilization, and deroofing and suction drainage of the cavity, addition of omentoplasty if required, and a follow-up exceeding 6 months. RESULTS: Eighteen patients (M11:F7) with 22 liver hydatid cysts underwent laparoscopic surgery. The mean cyst size was 7.4 cm (range, 5.6 cm to 16.6 cm). Two patients needed conversion to an open operation. Spillage of cyst contents occurred in 5 patients. True recurrence of hydatid disease occurred in the original site in 2 patients (11%), and false recurrence was seen in 2 patients (11%), all within 6 months. CONCLUSION: With proper patient selection, laparoscopic management of hydatid cysts of the liver is a feasible option with low rates of conversion. Both true and false recurrences are common with conservative laparoscopic options, and undetected ectocysts may be the cause of true cyst recurrence.     

Primary Hydatid Cyst of the Pancreas

Background: Hydatid cyst of the pancreas is rare, accounting for less than 1% of the various sites of hydatid disease, even in countries where echinococcosis is endemic. We report a case of pancreatic hydatid cyst to increase awareness for this important condition.

Case report: We describe a 33-year-old male with abdominal discomfort of one-year duration. On abdominal examination, there was mild tenderness with fullness in the right upper quadrant. Laboratory investigations revealed no abnormalities. Abdominal ultrasonography showed a cystic mass over the head of the pancreas. Abdominal CT scan confirmed the presence of a solitary cyst in the pancreatic head, with no enhancement on contrast CT. Indirect hemagglutination test for hydatid disease was negative. A pre-operative diagnosis of cystic neoplasm of the pancreas was made and laparo-tomy was done; on exploration there was a cystic mass arising from the head of the pancreas. A pericystectomy was carried out and the diagnosis of hydatid cyst of the pancreas was confirmed by histopathology. The postoperative period was uneventful and no recurrence was seen after 2 years of follow-up.

Conclusion: Pancreatic hydatidosis, though very rare, should be considered in the differential diagnosis of pancreatic cystic lesions in the appropriate epidaemiological setting.     

Laparoscopic cystectomy for splenic hydatid cyst: a case report

Even in countries where it is considered endemic, splenic hydatid cyst is a very rare disease in childhood. Partial or total splenectomy has generally been the treatment of choice for this condition. This is the first report of laparoscopic cystectomy as treatment of isolated splenic hydatid cyst in childhood. A 10-year-old girl with isolated splenic hydatid cyst was successfully treated by laparoscopic cystectomy and splenic preservation. The authors have demonstrated that laparoscopic cystectomy for an isolated splenic hydatid cyst is technically feasible, safe, and is associated with a shorter hospital stay and good cosmetic appearance.     

Obstructive jaundice caused by hydatid cyst rupture in main bile duct

Hydatid hepatic cyst rupture into bile duct is a complication of hydatid disease. The rupture is more frequent in right or left epatic duct and occasionally in common bile duct (7-9%). A 50-year old man came to emergency room owing to jaundice, fever and abdominal pain. TC show an hydatid cyst with daughter's cyst of left liver and dilatation of biliary tree. Laboratory data of significance included an increased of liver function tests (Bilirubin, Alkaline ph., SGOT, SGPT), VES and leukocytosis. The patients was surgically treated, by total pericystectomy, colecystectomy and coledocotomy with lavage o common bile duct; finally we placed one Kehr drainage and two abdominal drainage. After 15 days of postoperative hospitalization patient was discharged. The best treatment of hydatid cyst is total pericystectomy (when possible). An alternative surgical treatment is possible for the presence of communication with biliary tree. ERCP is very important for a correct diagnosis and for a complete surgical treatment.     

Extravisceral primary hydatid cyst of the retroperitoneum

BACKGROUND: Hydatid cyst (HC) continues to be endemic in the Mediterranean countries, such as Turkey. Living in a rural area is an important risk factor for the disease. HC is most commonly seen in the liver and lungs, but retroperitoneal hydatid cyst is very rare. The objective of this study was to evaluate the clinical and radiographic findings and surgical treatment of this unusual lesion. METHODS: Between 1979 and 2004, 14 cases with primary retroperitoneal hydatid cyst were treated surgically at our clinic. RESULTS: Symptoms included flank pain in eight (57.1%) and palpable mass in six patients (42.8%). The cyst was located in the right retroperitoneum in seven patients (50%), left retroperitoneum in five patients (35.7%), retrovesical region in one patient (7.1%) and paravesical region in one patient (7.1%). Surgical approaches were right paramedian extraperitoneal approach in four patients, left paramedian extraperitoneal approach in two patients and midline transperitoneal approach in eight patients. Total pericystectomy was chosen as the surgical procedure in all patients except in five (35.7%), who had partial cystectomy for cysts located near the vital structures. There were no complications and mortality postoperatively. CONCLUSION: A primary HC of the retroperitoneum is a distinct clinical entity that must be considered when caring for a patient with a retroperitoneal mass in endemic regions. It should be treated after the diagnosis is confirmed without any delay because of secondary spillages due to perforations and other possible complications.     

Kyste hydatique du muscle psoas révélé par une masse abdominale fébrile: A propos d’un cas

Primary retroperitoneal hydatid cysts of the psoas muscle are rare. We report the case of a 41-year-old patient who presented with a mass in the left iliac fossa associated with fever. Ultrasonography and CT scan showed a cystic mass on the left psoas muscle which proved to be an infected hydatid cyst. Partial pericystectomy was performed via a retroperitoneal approach. Based on this observation and a review of the literature, the authors discuss the diagnosis and treatment hydatid cysts of the psoas     

Hydatic cyst of the liver. Considerations on 337 cases

Hydatid disease of the liver is still endemic in certain parts of the world. The modern treatment of hydatid cyst of the liver varies from surgical intervention to percutaneous drainage or medical therapy. Surgery is still the treatment of choice and can be performed by the conventional or laparoscopic approach. The aim of the study is to analyze the results of the surgical treatment in hydatid disease of the liver in First Surgical Clinic, Ia?i. The study concerned a period of 12.5 years (1992 - 31.07.2004) and it included 337 cases. There were performed radical procedures (ideal cystectomy - 17 cases - 5.04%, hepatic segmentectomy - 8 cases - 1.48%, atypical hepatectomy - 10 cases - 2.96%) or conservative procedures (de-roofing - 37 cases - 10.97%, subtotal pericystectomy - 34 cases -10.80%, total pericystectomy - 19 cases - 5.63%, partial pericystectomy - 212 cases -62.90%). In 35 cases (10.38%) the operation was started laparoscopically and 12 cases needed conversion. Postoperative course was complicated in 112 cases (33.32%) (external biliary fistula, cavity suppuration, residual cavity hydatid relapse). Radical methods constituted operations that had excellent results, but they are feasible in few cases. Conservative procedures, relatively simple and still accepted, have a higher rate of morbidity. The laparoscopic approach is more and more used, with good results.     

Retroperitoneoscopic laparoscopic treatment of renal hydatid cyst in a child

A 17-year-old girl with the diagnosis of right renal hydatid disease was treated by retroperitoneoscopic technique. No complications occurred at peroperative and postoperative periods. There were no clinical symptoms and radiologic pathologic causes to show recurrence at postoperative second year. This is the first case that is reported via retroperitoneoscopic laparoscopic approach at the treatment of renal hydatidosis in children. We prefer retroperitoneoscopic approach to avoid intraperitoneal contamination. Retroperitoneoscopic laparoscopic treatment can be an alternative treatment technique at renal hydatidosis therapy because of its advantages to conventional surgery, Although further reports of its long-term outcomes and additional experiences are necessary.     

Cardiac involvement of hydatid disease

Objectives|Echinococcosis is a serious health issue occurring in some geographical region of the world. Cardiac involvement is rare and early diagnosis and prompt surgical intervention are critical.Subjects and Methods: Six patients with cardiac hydatid cysts underwent surgical treatment in our institution between April, 1996 and March, 2002. Five of the patients were female and one was male. Average age was 40±5 years with a range of 19 to 72 years. Cysts were located in the right ventricular outflow tract in two patients, the left ventricular outflow tract in one, the right atrial in one, the right ventricular in one and the right atrioventricular groove in one. Five patients were operated on using standard cardiopulmonary bypass techniques, and one was operated on without cardiopulmonary bypass.Results: In the perioperative and the early postoperative period, no cardiac problems was observed. On control echocardiography, a ventricular septal defect was detected in one patient in the late postoperative period. The ventricular septal defect was repaired using standard cardiopulmonary bypass and was closed with a teflon patch. Patients were followed up for a mean period of 3.4±2.5 years. No mortality or recurrence was observed during the follow-up period.Conclusions: When hydatid cyst is diagnosed, the possibility of cardiac involvement should also be investigated. The treatment of cardiac hydatid cyst is surgical extraction of the cyst.     

Management of complicated hydatid cyst of the thorax

BACKGROUND: Complicated hydatid cyst of the thorax is important to the clinical approaches and treatment methods in hydatid disease. The aim of this study was to evaluate the problems of complicated pulmonary hydatid cyst, including choice of surgical methods, diagnostic clues and to discuss the inherent risks of medical therapy and the delay of surgical treatment in pulmonary hydatid disease. METHODS: Between 2002 and 2006, 40 operations were carried out in 37 patients whose diagnoses were complicated hydatid cyst. The surgical approach was a posterolateral thoracotomy in all patients; a phrenotomy in two patients and a thoracoabdominal approach in one patient and two-stage bilateral thoracotomy in four patients. The preferred surgical treatment procedure was cystotomy and modified capitonnage, which was carried out in 26 patients (70%). Other procedures included a cystotomy in five (14%) and decortication in six (16%) patients. Segmentectomy was carried out in 1 (3%), and wedge resection in four patients (11%). RESULTS: In 25 patients (67.5%), there were single hydatid cysts; whereas 12 patients (32.5%) had multiple cysts. Eleven patients had preoperative hydatid cyst history. Iatrogenic rupture of an intact hydatid cyst occurred in three patients. Extrathoracic involvement was apparent in 10 patients (27%). Intrathoracic but extrapulmonary involvement was apparent in six patients (16%). The morbidity ratio was 5%; there was prolonged air leak and atelectasis in one patient each. The mortality ratio was 3% (one patient). The average hospitalization duration for all patients was 5.7 days (range, 3-17 days). The mean follow up was 18.4 months with no recurrence. CONCLUSION: Complicated hydatid cyst may have different clinical manifestations and may present radiologically as a primary lung tumour. In patients with suspicious lung masses owing to endemic area, history of a hydatid cyst or contralateral or extrathoracic hydatid cyst involvement at the same time should indicate a complicated pulmonary hydatid cyst. Preoperative anthelmintic therapy must be avoided owing to the risk of perforation. Treatment of a complicated hydatid cyst differs from that of an intact hydatid cyst. Anatomic resection may be necessary owing to destroyed lung tissue secondary to suppuration from a hydatid cyst; however, parenchymal preserving surgery is preferable in an uncomplicated hydatid cyst. A modified capitonnage method is recommended for complicated hydatid cyst treatment as it has a low morbidity rate.     

Laparoscopic management of an isolated primary omental hydatid cyst: A case report and literature review

Primary isolated omental hydatid cysts are extremely rare. Usually, omental hydatid cysts are secondary, either resulting from spontaneous spread of cysts or occurring after operations involving hydatidosis in other regions. Here, we report a case of a primary isolated omental hydatid cyst treated with a laparoscopic approach.We report a 16-year-old female who admitted to hospital with right upper quadrant pain. Abdominal ultrasonography and computed tomography (CT) revealed a cyst located between the liver and right kidney. The cyst was enucleated from the omentum and removed with a laparoscopic approach. Histopathologic examination revealed a hydatid cyst. There was no recurrence during 3 years of follow-up. Primary isolated omental hydatid disease should be considered in patients in endemic regions with intra-abdominal cysts. Laparoscopic surgery seems to be effective and safe for hydatid cysts in accessible locations.     

腹腔镜在肝包虫病手术中的应用

本文通过归纳总结权威医学数据库上所有关于腹腔镜治疗肝包虫病的文章,对这一领域的进展和现状进行回顾并评论.在国内外,各种开腹治疗肝包虫的代表性手术方式,目前腹腔镜都已全面开展.20世纪90年代初开展的腹腔镜下包虫囊肿穿刺引流术为腹腔镜治疗肝包虫病奠定了最初的基础,腹腔镜内囊摘除术凸显了多方面优势.而腹腔镜外囊剥离术由于"根治"而又微创的优势,复发率低,是最理想的手术方式,虽国内外至今开展例数较少,却昭示了广阔的前景.腹腔镜肝叶、肝段切除术由于手术的高风险、高难度受到限制,处于探索阶段,适应证最为狭窄.     

腹腔镜手术治疗肾囊肿56例报告

目的:探讨腹腔镜治疗肾囊肿的手术方法及疗效。方法:回顾分析56例肾囊肿患者全麻经腹腔或腹膜后途径行腹腔镜肾囊肿去顶减压术的临床资料。结果:53例手术成功,经腹膜后途径3例中转开放手术。手术时间40~150min,平均60min,术中出血10~100ml,术后无严重并发症发生,住院时间5~7d。41例术后随访3~6个月,无囊肿复发。结论:腹腔镜肾囊肿去顶减压术具有患者创伤小、术后康复快、疼痛轻等优点,是治疗肾囊肿安全有效的方法。     

Laparoscopic management of benign cystic lesions of the liver

We present our experience in the laparoscopic management of benign liver cysts. The aim of the study was to analyze the technical feasibility of such management and to evaluate safety and outcome on follow-up. Between September 1990 and October 1997, 31 patients underwent laparoscopic liver surgery for benign cystic lesions. Indications were: solitary giant liver cysts (n = 16); polycystic liver disease (PLD; n = 9); and hydatid cysts (n = 6). All giant solitary liver cysts were considered for laparoscopy. Only patients with PLD and large dominant cysts located in anterior liver segments, and patients with large hydatid cysts, regardless of segment or small partially calcified cysts in a safe laparoscopic segment, were included. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospectively. The procedures were completed laparoscopically in 29 patients. The median size of the solitary liver cysts was 14 cm (range, 7–22 cm). Conversion to laparotomy occurred in 2 patients (6.4%), to control bleeding. The median operative time was 141 min (range, 94–165 min) for patients with PLD and 179 min (range, 88–211 min) for patients with hydatid cysts. All solitary liver cysts were fenestrated in less than 1 h. There were no deaths. Complications occurred in 6 patients (19%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts. Three patients were transfused. The median length of hospital stay was 1.3 days (range, 1–3 days), 3 days (range, 2–7 days), and 5 days (range, 2–17 days) for solitary cyst, PLD, and hydatid cysts, respectively. Median follow-up was 30 months (range, 3–78 months). There was no recurrence of solitary liver cyst or hydatid cysts. One patient with PLD presented with symptomatic recurrent cysts at 6 months, requiring laparotomy. We conclude that laparoscopic liver surgery can be accomplished safely in patients with giant solitary cysts, regardless of location. The laparoscopic management of polycystic liver disease should be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through an open approach. Received for publication on Aug. 21, 1999; accepted on Sept. 2, 1999