Surgical management for hydatid disease

Hydatid disease is caused by the parasite Echinococcus granulosus. The liver and the lungs are common sites. When a cystic lesion is seen on CT scan, diagnosis is made based on the patient having lived in an endemic area. Serologic tests are used for differential diagnosis. Medical treatment is centered on albendazole. Surgery is recommended either by open or endoscopic technique depending on the characteristics of the cysts and the patient. Complications of surgery are rare except for prolonged air leaks. Mortality occurs when the cyst is located in the central nervous system or occludes major vessels.     

Surgical management of hydatid disease of the liver

The authors review 143 consecutive, surgically treated cases of hydatid disease of the liver seen over the past 10 years. Of the 208 cysts found, 82 (39.4%) were complicated; the remainder were simple. The complications included rupture into the biliary system (16.3%), suppuration (11.0%), partial calcification of the pericyst (5.8%), intraperitoneal rupture (4.8%), bronchobiliary fistula (0.9%) and cystocutaneous fistula (0.5%). External capitonnage was the most commonly used surgical technique (63.0%), followed by cystectomy (17.8%), omentoplasty (10.6%), tube drainage (7.7%) and cystojejunostomy (0.9%). Capitonnage was carried out with or without tube drainage. The complications of surgery were higher with drainage than without. The main complications of surgery were infection in the residual cavity and biliary fistula. The patients who underwent external capitonnage without drainage or omentoplasty had good results with minimal complication rates (3.5% and 4.5% respectively). For the patients in whom the cystectomy was established, the complication rate was 8.1%.     

Surgical treatment of bilateral hydatid disease of the lung

Objective: To evaluate the various tactics and approaches in the surgical treatment of bilateral pulmonary hydatidosis (BPH). Materials and methods: Between 1969 and 2000, a total of 127 BPH patients underwent surgery. The operative techniques of choice were parenchyma-preserved methods. Up to 1988, two-stage operations via thoracotomies were performed on 30 patients. One-stage operations with successive thoracotomies were carried out on two patients. Since 1988, only four patients underwent two-stage operations. One-stage surgery was carried out on 91 patients: 82 via median sternotomy (MS), one via clamshell incision, four through successive thoracotomies and three through video-assisted thoracic surgery (VATS) and mini-thoracotomies. One-stage bilateral lower lobectomies via MS were performed on one patient. In 11 cases, the concomitant dome localized liver cysts were extirpated via right phrenotomy during MS. Sterno-laparotomy was performed on 11 patients: for associated hepatic (seven), and hepatic and spleen cystectomies (four). In eight cases, abdominal echinococcosis was operated on a second stage, and in one case, a complicated hepatic cyst was extirpated on a first stage. Results: No intraoperative deaths occurred. The postoperative mortality rate was 0.78%; one patient died of pulmonary embolism. No fatal complications have appeared in eight cases (skin suppuration, residual pleural cavity and atelectasis). Adult respiratory distress syndrome was successfully treated in one case after MS. The long-term postoperative results are considered very good, with no recurrences observed. Conclusions: One-stage surgery is superior to a classic two-stage approach as it decreases the morbidity, hospital stay and costs. MS is an excellent approach, but in some cases, VATS mini-thoracotomies could be indicated.     

Surgical management of complicated hydatid disease of the liver

Increased worldwide travel and immigration have led to an increase in the incidence of hepatic hydatid disease outside of endemic areas. In nonendemic areas lack of familiarity with the disease may lead to a delay in diagnosis with increased risk for development of complicated disease. Complicated disease is defined as: infected cysts, cysts with a hyperechoic solid pattern or calcified walls, or cysts with biliary rupture. Over a 6-month period six patients with complicated hydatid disease were referred to our institution. All six patients were immigrants from endemic areas and were found to have complicated hepatic hydatid disease including cholangitis and intrabiliary rupture. Patients were treated with oral albendazole for 3 weeks before operation and oral praziquantel for 2 days preoperatively. Surgical therapy consisted of subtotal cystectomy, cholecystectomy in all patients, and cystic duct biliary decompression-drainage in five patients. The one patient without biliary drainage developed a postoperative bile leak that resolved with endoscopic biliary stenting. All patients received albendazole for 3 months postoperatively and were free of disease at 6 to 24 months follow-up. We conclude that although nonoperative management with percutaneous drainage or medical management alone may be successful in patients with uncomplicated disease operation remains the therapy of choice for complicated hydatid disease.     

Surgical treatment of hepatic hydatid disease

The results of surgery in 48 patients with hepatic hydatid disease are described. In 26 out of 32 patients with uncomplicated cysts, conservative surgery with obliteration of the cyst cavity by omentoplasty gave satisfactory results. In contrast, 16 patients with cysts complicated by pyogenic infection or cholangitis required a variety of surgical procedures, including prolonged tube drainage, exploration of the common bile duct, sphincterotomy/plasty and hepatojejunostomy to achieve a satisfactory outcome. The group with complicated cysts also had a much longer postoperative stay (median 30 days) than those with uncomplicated cysts (median 14 days). Two patients died: in one, post-mortem examination revealed carcinoma in the wall of the cyst.     

Minimal change glomerulonephritis associated with hydatid disease

A 63-year-old man presented to our department with dyspnea and peripheral edema. A cystic mass in the right upper abdomen, consistent with echinococcal disease was discovered. Proteinuria was also present, and a nephrotic syndrome was diagnosed. The kidney biopsy revealed minimal change glomerulonephritis. Treatment with the antiechinococcal drug albendazole induced complete remission of the nephrotic syndrome, suggesting an etiopathogenic role for a hydatid antigen in the development of an immune-mediated glomerulonephritis.     

冠心病合并二尖瓣关闭不全的外科治疗

目的　探讨冠心病合并二尖瓣关闭不全 (MR)的外科治疗方法。方法　 1994年 4月至2 0 0 0年 10月 ,同期手术治疗冠心病合并MR病人 34例 ,其中二尖瓣轻度反流 1例 ,中度反流 2 5例 ,重度反流 8例。二尖瓣的病理改变主要表现为单纯瓣环扩大、瓣叶脱垂或二尖瓣腱索断裂。手术均在低温体外循环下进行。二尖瓣成形 (MVP) 2 7例 ;单纯二尖瓣前交界或双交界折叠环缩 15例 ;脱垂瓣叶切除后再缝合 9例 ;二尖瓣前叶脱垂部分直接缝合到相应的后叶形成双孔二尖瓣 3例 ;应用二尖瓣瓣环 2 0例 ;二尖瓣置换 (MVR) 7例 ,均选择机械瓣。结果　无手术或住院死亡和严重并发症。超声心动图检查提示平均左室舒张末径为 (5 3 0± 6 3)mm ,与术前比较差异有显著性 (P <0 0 1)。 31例平均随访 2 9个月。无远期死亡。病人生活质量均明显提高。心功能I～II级 2 8例 ,III级 3例。超声心动图检查提示微量二尖瓣反流 6例 ,少至中度反流 3例。机械瓣功能正常。结论　冠心病合并中度以上MR应积极处理 ,二尖瓣成形应为首选     

Surgical management of tricuspid regurgitation associated with acquired valvular disease

The best means of managing tricuspid regurgitation associated with acquired valvular disease is still controversial. During the period from 1978 to 1988, 111 patients who had tricuspid regurgitation along with associated valvular dysfunction were treated in Kagoshima University Hospital. Patients with moderate to severe regurgitation underwent annuloplasty in 61 (Carpentier's in 39, DeVega's in 20, and Kay's method in 2) and valve replacement in 8. Forty-two patients were treated conservatively on the tricuspid valve because of mild regurgitation. We found the results to be less satisfactory with a high incidence of postoperative deaths and residual tricuspid regurgatation in the group treated by annuloplasty with a Carpentier ring than in the other two groups of annuloplasty or in the group of valve replacement. We conclude the modified DeVega's method is the first choice for annuloplasty in patients with mild to moderate regurgitation, and we believe it appropriate to replace the valve in an increasing number of subjects which have severe regurgitation.     

Surgical treatment of hepatic hydatid disease.

The results of surgery in 38 patients with hepatic hydatid disease are described. Cystectomy was done in four patients with small peripheral cysts. For them the mean postoperative stay was 8.2 days. Partial cystectomy, introflexion and omentoplasty were performed in 28 patients with uncomplicated large cysts. The mean postoperative stay for these patients was 8.6 days. One patient in this group died of massive hemorrhage and disseminated intravascular coagulation. Exploration of the common bile duct and choledochoduodenostomy were required in three patients who had large cysts complicated by rupture into the biliary tree. This complication resulted in a mean postoperative stay of 11.5 days. Three patients who had cysts complicated by pyogenic infection were treated with tube drainage. They were discharged with their tubes in place after a mean hospital stay of 26.5 days. Hydrogen peroxide 10% was used as a scolicidal agent and was successful in preventing dissemination. All patients underwent ultrasonography 3 months after surgery, and 28 (74%) were followed up by annual examination. There was no recurrence after a mean follow-up of 2.7 years. The results suggest that surgical treatment of hepatic hydatid disease should be governed by the size, location and complications of the cyst. The combination of partial cystectomy, introflexion and omentoplasty was safe and effective therapy for patients with large hepatic cysts uncomplicated by pyogenic infection.     

Surgical management of symptomatic hydatid liver disease: experience from a Western centre

Background

Hydatid liver cysts are rare in North America. The objective of this study was to determine the optimal surgical management for hydatid liver cysts treated outside endemic areas.

Methods

We reviewed the cases of consecutive patients who underwent management of hydatid liver cysts. Radical liver resections were compared with other types of procedures. Clinical presentation, investigations, perioperative outcomes and long-term follow-up were evaluated. We evaluated disease recurrence using the Kaplan–Meier method.

Results

Forty patients underwent surgery for hydatid liver cysts. Most patients had single (68%) right-sided (46%) cysts with a median size of 10 cm. Most (83%) underwent liver resection with or without drainage/marsupialization. Radical liver resection was carried out in 60% (19 major, 5 minor). Additional procedures were required in 50% (biliary fistulization 30%, diaphragmatic fistulization 20% or paracaval location/ fusion 8%). Postoperative complications occurred in 48%. The median follow-up was 39 months. The 3-year recurrence-free survival was significantly different between patients who had radical resection and those who had other procedures (100% v. 71%, p = 0.002).

Conclusion

The surgical management of hydatid liver cysts in North America remains rare and challenging and is frequently associated with fistulizing complications. Excellent long-term outcomes are best achieved using principles of radical liver resection that are familiar to North American surgeons.