Results of laparoscopic treatment of hydatid cysts of the liver

Background We have previously reported on the laparoscopic treatment of hydatid cysts of the liver. We now report the successful treatment of 18 cysts in 12 patients with a median follow-up of 12 months. Methods The standard treatment in the open technique was performed laparoscopically. The main concern was to prevent spillage of the hydatid fluid, for which the puncture and evacuation of the cyst is carried under scolicidal agents cover using 1% cetrimide, thus decreasing the chances of recurrence. Results In this group of patients we had one biliary leak that ceased spontaneously and one recurrence of hydatid cyst but not in the same lobe. Conclusions We conclude that laparoscopic evacuation of hydatid cysts is a successful operation comparable to the open technique, with the added advantages of the laparoscopic approach.     

Evacuation of hydatid liver cysts using laparoscopic trocar

Several methods of reducing the likelihood of spilling live scolices during surgical removal of hydatid liver disease have been described. The aim was to determine the effectiveness and safety of laparoscopic trocar insertion for evacuation of hydatid liver cysts. This technique was used for 30 cysts in 19 patients who had surgery for hydatid liver disease. After establishing protection of the operative area, a laparoscopic trocar was inserted into the cyst at the most prominent point and the cyst was aspirated with large-bore suction and filled with a scolicidal agent. The technique was not attempted in two small cysts (<6 cm) located near the major blood vessels or in a single intraparenchymal cyst. Insertion of the trocar was successful in all remaining cysts, and there were no complications during the insertion or the evacuation. Successful evacuation (excellent and good outcomes) in unilocular, multilocular, and degenerated cysts were 100%, 84%, and 57%, respectively (p = 0.144), with a total success rate of 82%. Although successful evacuation was achieved in both anterior (92%) and posterior-superior located cysts (73%) (p = 0.203), excellent outcomes were higher for the anterior cysts (73%) than for the posterior-superior cysts (13%) (p = 0.005). Successful evacuation outcomes for the large (> 10 cm), middle-sized (6 to 10 cm), and small cysts (<6 cm) were 100%, 79%, and 67%, respectively (p = 0.591). The patients have been followed for a mean of 11 months (range 3 to 24 months), and no recurrence has been recorded. Insertion and evacuation of the hydatid liver cysts with a laparoscopic trocar is a safe and effective procedure, and its limitations are minimal.     

Laparoscopic treatment of hydatid liver cysts

Laparoscopic hepatic hydatidectomy (LHE) was performed in 37 patients. Conversion to laparotomy in one case was caused by intrahepatic location of liver cyst. In 36 patients after LHE, the postoperative period was significantly easier than after standard operation. There were the following complications: bile efflux in abdominal cavity (1), bile efflux from residual cavity (2), suppuration of residual cavity (1). The complications were removed without laparotomy, all the patients recovered. The patients were discharged on day 5.6 on the average. LHE is a promising method of surgical treatment for uncomplicated liver echinococcosis.     

Surgical treatment of hydatid cysts of the liver

BACKGROUND: Echinococcosis is a zoonotic disease that occurs throughout the world. The purpose of this study was to assess the clinical features and results of surgical treatment of hepatic hydatid cysts. METHODS: One hundred and two patients operated on between 1991 and 2002 were reviewed retrospectively. The patients' demographic data, location, number and size of cysts, type of surgical procedure performed, morbidity, recurrences and duration of hospital stay were recorded. RESULTS: There were 74 male and 28 female patients with ages ranging from 15 to over 60 years. The most frequent symptom was abdominal pain. From the total of 136 hepatic cysts, 54 (39.7 per cent) were managed by cystostomy and drainage, 40 (29.4 per cent) by cystostomy and capitonnage, 16 (11.8 per cent) by cystostomy and omentoplasty, 24 (17.6 per cent) by cystectomy and two (1.5 per cent) by left lateral hepatic resection. Postoperative complications were more frequent following cystostomy with omentoplasty (six of 16 patients) compared with cystectomy (none of 18) (P = 0.005). Choledochotomy increased the length of hospital stay in patients having cystostomy and drainage (P = 0.021) and in those having cystostomy with omentoplasty (P = 0.028). Two recurrences were observed. CONCLUSION: Surgery combined with medical treatment by albendazole is effective in the eradication of hepatic hydatid disease and in the prevention of local recurrence.     

Laparoscopic treatment of hydatid cysts of the liver

We report for the first time treatment of hydatid cyst of the liver laparoscopically. The patient is a 27-year-old man who presented to our hospital with a 6-week history of recurrent right-upper-quadrant pain with abdominal ultrasound findings compatible with hydatid cyst of the liver. The cyst was approached laparoscopically using the same hydatid asepsis as in open surgery. The cyst was evacuated laparoscopically and marsupialized, and its remaining cavity was packed with omentum. The patient did well postoperatively and was discharged home on the third postoperative day. He had minimal biliary leak that ceased spontaneously on the fifth postoperative day.     

A new instrument,the "Perfore-Aspirator" for laparoscopic treatment of hydatid cysts of the liver

The authors introduce a new instrument functioning as both perforator and aspirator in the laparoscopic management of hepatic hydatid cysts. Between January 1998 and January 2002, 11 laparoscopic cystotomy + partial cystectomy + drainage procedures were performed for eight consecutive patients. Eight of the cysts were located in the right lobe, and the remaining three in the left. The average diameter (+/-SD) of the cysts was 9.6 +/- 3.66 cm, and the mean age of the patients was 31.3 +/- 7.24 years. The diagnosis was confirmed by ultrasonography and/or computerized tomography. The procedure was performed with the help of three ports. The "perfore-aspirator" instrument (Bahadir Tibbi Aletler A. S., Samsun, Turkey) was introduced through the 10-mm trocar at the subcostal area, and the cystotomy procedure was done with success. Then, a partial cystectomy procedure was performed with the use of a grasper and scissors attached to an electrocautery device. The average hospitalization period was 5 +/- 1.69 days. No major morbidity or mortality was seen. All patients were treated with albendazole preoperatively and postoperatively.     

Laparoscopic treatment of hydatid cysts of the liver and spleen

Background: The short-term results from laparoscopic treatment of hydatid cysts of the liver and spleen were reported previously. The procedure was shown to be feasible and safe, offering the advantages of laparoscopic surgery. This is the first report on the long-term follow-up of this operation in a large group of patients. Methods: In this study, 108 hydatid cysts of the liver and spleen in 83 consecutive patients (43 males [52%] and 40 females [48%]) were approached laparoscopically. The mean age of the patients was 40 years (range, 13–85 years). There were 104 liver cysts and 4 spleen cysts. The liver cysts were located in the right lobe in 42 patients (53%), in the left lobe in 21 patients (26%) and in both lobes in 16 patients (21%). Of the 104 cysts, 44 (42%) were uniloculated and 60 (58%) were multiloculated. Results: All cysts were approached laparoscopically. The mean operative time was 80 min (range, 40–180 min). The conversion rate was 3%. The mean hospital stay was 3 days (range, 2–7 days). There were no mortalities, and complications occurred in nine patients (11%). All were managed conservatively except one patient in whom a laparotomy was needed. All patients were followed up for a mean period of 30 months (range, 4–54 months) with serological testing and ultrasonography if needed. In three patients (3.6%) recurrence of the disease developed. Conclusion: The laparoscopic approach to uncomplicated hydatid cysts of the liver and spleen is a safe and effective option with favorable long-term results. Received: 27 August 1998/Accepted: 13 July 1999     

Percutaneous treatment of the liver hydatid cysts under sonographic guidance

This paper is a retrospective study of the first 51 cases of liver hydatid cysts, which underwent a conservative treatment between April 1996-December 2000. There were 28 females and 23 males with a mean age of 40.1 years (7-65), which had 63 liver hydatid cysts. In the right liver lobe were located 46 cysts, in the left liver lobe were located 7 cysts and in 10 cases cysts were located in both liver lobes. In 4 cases a pulmonary hydatidosis was associated. Abdominal ultrasound and CT scan were routinely performed and the cysts were classified in type I and II after Gharbi's classification. All of these 63 cysts were treated by ultrasound guided fine-needle percutaneous puncture with aspiration and instillation of sterile alcohol 95 degrees. Pre and postoperative the patients were treated with mebendazol or albendazol. They were followed-up by ultrasound and CT scan examination in the second day postoperative and monthly. No new cysts were noted during an average follow-up of 14.7 months and maximal cyst diameter decreased with minimum 72%. Two episodes of reversible anaphylaxis were encountered. The mean hospital stay was 3.3 days. In this paper the indications for conservative treatment and preliminary results of this method are discussed.     

The use of a large,transparent cannula,with a beveled tip,for safe laparoscopic management of hydatid cysts of liver

Aspiration of hydatid cysts and instillation of scolicidal fluid as part of the surgical treatment should be done very carefully to prevent any spillage that might cause anaphylaxis and dissemination of the disease. We describe herein a laparoscopic technique for safe aspiration of hydatid cysts of liver by using an assembled large, transparent trocar sleeve with a beveled tip. The method described allows laparoscopic access even to hydatid cysts that are located under the diaphragm.     

Complicated hydatid cysts of the liver]

In 328 cases of hydatid disease of the liver operated between 1979 and 1989, 51 (15.8%) had complicated cysts. The most frequent complication was intrabiliary rupture (2/3 of all complications). The others were intraperitoneal rupture in 7 cases (13.8%), suppuration in 7 cases (13.8%) and intrathoracic rupture in 3 cases (5.8%). Among the intrabiliary ruptured cysts, T-drainage was performed in 15 cases, choledochoduodenostomy was performed in 12 cases, and sphincteroplasty was performed in 7 cases. The cases of intraabdominal rupture were operated immediately. The suppurated cysts were marsupialized in 3 cases and drained in 4 cases. The 3 cases of bronchobiliary fistula were treated by T-tube drainage of the common bile duct, drainage of the pleural space, repair of the diaphragm and closure of the communicating bronchus. In this series, the mortality rate was 7.8% and the recurrence rate was 9.8%.     

Surgical treatment of hydatid cysts of the liver in the era of percutaneous treatment

BACKGROUND: Although surgery is the recommended treatment for liver hydatid disease, percutaneous treatment has been introduced as an alternative to surgery. No previous studies have been reported for patients who have not been suitable for percutaneous treatment and undergone surgery. The aim if this study was therefore to evaluate the patients who have liver hydatid disease and not suitable for percutaneous treatment and to determine the effectiveness of different types of surgical interventions in these patients. PATIENTS AND METHODS: Ninety-five patients who underwent operations for liver hydatid disease were retrospectively reviewed. All patients were radiologically evaluated before surgery for possible percutaneous treatment. Besides other related factors, conventional and radical surgical approaches were compared in terms of complication and recurrence rate. RESULTS: Overall complication and recurrence rates were 40% and 25%, respectively. Conventional surgical approaches and common bile duct exploration were significantly associated with an increased complication and recurrence rate. CONCLUSIONS: Selection of simple liver hydatid cysts for percutaneous treatment had led us to operate more difficult and complicated cases. It seems that routine use of endoscopic retrograde cholangiography in the preoperative period and more efforts to perform radical procedures are two major determinants in the successful treatment of theses complicated cases.     

Surgical treatment of hydatid cysts

Hydatidosis represents a form of helminthic zoonosis with a stronger medical, social and economic impact. It is endemic in some areas of the world including Mediterranean countries, and therefore Italy. The disease is often diagnosed in an advanced phase, due to the poor symptomatology in the early stages. The best treatment is surgery. Emergency surgery is similar to elective surgery, though in some cases is preferable only a drainage procedure until the stabilization of the genreal and local conditions of the patient allow a radical intervention. The Authors report on their five year experience of surgical treatment of compliated pulmonar hydatidosis pointing out that exeresis must be aimed at preserving pulmonar function as much as possible.     

"The fate" of a peri-cystic-jejunostomy in the treatment of the hydatid liver cysts

The persistence of a hepato-jejunal fistula after 9 years from a peri-cystic-jejunostomy in the treatment of hydatid liver cysts is an amazing condition. We discover this kind of fistula during the operation for cholelithiasis. This association between fistula and a "after-hydatid" choledocholithiasis is an opportunity to discuss some pathogenic and evolutive mechanisms about both of two entities.     

Laparoscopic approach to hydatid liver cysts

Background: In recent years attempts have been made to treat hydatid liver cysts laparoscopically. The purpose of this study was to evaluate different aspects of this approach and to examine whether a reasonable model could be developed. Methods: Three different subjects were analyzed. In the first, physical aspects related to transmembrane pressures were analyzed to demonstrate that evacuation of the cyst under pneumoperitoneum does not carry increased risk of spillage, and may even offer an advantage when the proper technique is used. In the second subject, an isolated liver model of a goat was used to study several techniques for evacuating hydatid cysts without spillage. This was tested qualitatively by demonstrating scolices in the fluid medium around the isolated liver after surgical manipulations. In the third subject, the implication of the technique was evaluated in human patients. Results: According to basic physical assumptions, the following conclusions were reached: (1) The increase in intracystic pressure is equal to or less than the increase in intraperitoneal pressure after pneumoperitoneum. (2) Aspiration of parasitic cysts by laparoscopic needle through a large cannula under ``vacuum'' or by sealing the cannula and adhering it to the liver by cyanoacrylate or fibrin glue was found to be very safe. Simple needle aspiration failed to prevent spillage. (3) A new transparent cannula 18 mm in diameter with a beveled tip was designed that enables good accessibility to liver cysts and safe evacuation even of huge and complex cysts. Conclusions: The novel technique to manage hydatid liver cysts, described in the study, is feasible, sensible, and safe. The isolated goat liver containing hydatid cysts can be used as a reliable animal model to test new techniques in the future.