Surgical tactics in complicated pulmonary echinococcosis]

The authors analyse treatment of 326 patients with hydatid disease of the lungs. Complications were found in 112 (34.3%) of them. Broncho-fibroscopy was included in the complex of therapeutic measures in rupture of the cyst into the bronchus, and pleural puncture, therapeutico-diagnostic thoracoscopy and drainage of the pleural cavity in rupture into the pleural cavity. Temporary occlusion of the draining bronchus with Fogarty's catheter was conducted to prevent intraoperative aspiration complications. If organ-preserving operations are indicated, preference is given to A. A. Vishnevsky's echinococcectomy with a laser scalpel since the Delbet's method is fraught with the danger of cutting of the sutures due to acute inflammatory changes of the wall with the formation of a residual cavity or an abscess of the lung. A differentiated approach to preoperative management and the choice of the operative techniques reduced the incidence of postoperative complications and reduced mortality in complicated hydatid disease of the lungs to 0.9%.     

Surgical treatment of suppurative hydatid echinococcosis of the liver]

Among 140 patients with hydatid echinococcosis of the liver complications were noted in 58 cases: suppuration of the cyst - in 38 (27.1%), cyst rupture in the anterior abdominal wall and abdominal cavity - in 4 (2.8%), in bile ducts - in 10 (7.1%), its rupture into the right lung lower lobe, calcification of the cyst was noted in 4 patients (2.8%). It is concluded that open echinococcotomy with partial excision of the fibrous capsule and drainage of the residual cavity with a rubber tube seem to be the most effective operation for suppurative echinococcosis of the liver.     

Surgical therapy of liver echinococcosis

There is still no other therapeutic management for echinococcosis of the liver than surgical treatment. Indeed, drug therapy with Mebendazol prevents parasitosis from spreading. However, a complete regression has not been observed hitherto. Surgical procedure is dependent on expansion, localisation and type of echinococcosis. Generally, cystectomy is possible and adequate in case of Echinococcus granulosus, in case of Echinococcus multilocularis with its infiltrating growth, a complete healing can only be attained by lobectomy. With the hilus being invaded and obstructive jaundice proceeding, an improvement can be reached by Mebendazol or a palliative endless drainage tube.     

Surgical approach in bilateral and combined echinococcosis of the lung

One hundred and two patients aged from 4 to 65 years with echinococcosis were treated. Solitary cysts in both lungs were diagnosed in 69 patients, multiple cysts -- in 33 patients. In 10 cases small and middle cysts were in the upper parts of both lungs. These patients underwent one-stage operation consisting in lateral thoracotomy, removing of the cyst from one lung, incision of retrosternal mediastinal pleura, removing of the cyst from the second lung, drainage of pleural cavity. Fifteen patients with combined echinococcosis of the upper lobe of the right lung and liver were operated with another one-stage surgical method through thoracotomy in the third and sixth or seventh intercostal space. These methods are characterized by low traumaticity, decreased number of postoperative complications and hospital stay.     

Surgical therapy of cystic echinococcosis of the liver

This study analyses the results of a surgical deroofing technique that was used for the treatment of cystic echinococcosis of the liver in our institution during the last 18 years. The deroofing technique was used on 106 of 132 patients from January 1981 to December 1998. Other operative techniques (pericystectomy, hemihepatectomy) were performed on 26 patients. In 12 cases (9%) the operative procedure was completed by interventions at the extrahepatic bile ducts. 99 patients (75%) showed one or two cysts, and the remaining 33 patients (25%) had three or more cysts in the liver. 18 (14%) patients had to be reoperated on account of complications: in 5 cases a postoperative hemorrhage, in 11 cases a bile duct leakage and in 2 cases an intraabdominal abscess had to be treated operatively. The follow-up of 74 patients (81%) revealed recurrent disease in 14 (19%) cases. Surgical deroofing of cystic echinococcosis of the liver is easy to perform and in contrast to other minor surgical interventions universally applicable. The recurrence rate and the rate of postoperative complications are comparable to other minor surgical techniques. Therefore in our view this procedure represents the therapy of choice.     

Surgical treatment of alveolar echinococcosis of the liver

Cure of alveolar echinococcosis of the liver can be achieved by complete removal of the lesion, this being possible only by hepatic resection. Nevertheless, 25% of patients have unresectable lesions. The purpose of this work was to analyze the clinical sequelae and prognosis of patients after curative and palliative surgery for alveolar echinococcosis of the liver. The 10-year survival rate of patients who underwent hepatectomy with complete resection of the lesion was 100% compared with 63% in the patients who had hepatectomy with incomplete resection of the lesion. Thirty-seven patients with unresectable hepatic echinococcosis were divided into two groups; the 10 patients in group A underwent only exploratory laparotomy, and the 27 patients in group B had palliative surgery. In group B, marsupialization or cyst drainage was performed in 17 patients, biliary drainage in 6 patients, and biliary reconstruction in 4 patients. The outcome after surgery was compared in the two groups. The 5-year survival of the patients in group A was 30%, and all patients died of liver failure within 7 years. The survival rates of patients in group B were 60% at 5 years, 55% at 10 years, and 35% at 15 years. Complete removal of the lesion by hepatectomy results in satisfactory prognosis. Palliative surgery may offer improvement in terms of survival and quality of life when complete removal is not possible.     

Hepatic echinococcosis. Surgical treatment]

After some general observations on liver echinococcosis (epidemiology, liver topographic anatomy, diagnostics), various surgical techniques proposed for the treatment of this disease are described. Case series observed from 1967 to 1978 and the technique of choice, cystotomy with partial cysto-resection, are presented. The favourable results obtained are underlined.     

Surgical tactics in gangrenous and perforative cholecystitis]

Operations were conducted on 253 patients with acute cholecystitis, which was gangrenous in 84 (33.2%) and perforative in 7 patients. No relation was found between the frequency of these forms and the patients' age and duration of the disease. Quite frequently the clinical picture did not correspond to the morphological changes in the gallbladder wall. On 17 (20.23%) patients the operation was performed in the first 24 hours after hospitalization and circumscribed or generalized peritonitis was often found; 57 patients (67.85%) underwent operation on day 2-3 and infiltration was found in 24 and circumscribed peritonitis in 8 patients; in 10 cases the operation was conducted after day 3, the clinical manifestations of the disease were scarce. All were treated by cholecystectomy, postoperative complications developed in 5 (5.95%), 2 (2.38%) patients died. The authors recommend more active surgical tactics and claim that cholecystectomy in the most substantiated operation which can be practically carried out in all cases.     

Surgical tactics in acute gastrointestinal hemorrhage]

The results of treatment of 595 patients with acute gastro-intestinal bleeding are presented. Ulcer disease is the most frequent cause of bleeding. In its diagnosis, the use of gastroduodeno-fibroscopy is effective. In ineffective conservative therapy, the operative intervention is indicated.     

Surgical tactics in the esophago-gastric hemorrhages of liver cirrhosis patients

The character of the source and rate of bleeding were taken into consideration in determining the surgical tactics in 342 patients with cirrhosis of the liver complicated by gastro-esophageal bleedings and with high risk of their appearance. The operation of choice is thought to be arrest of the gastro-esophageal collateral blood flow. At high portal pressure or its considerable growing after the separating operation the latter should be associated with vascular anastomosis. When cirrhosis of the liver is associated with ulcer disease of the duodenum the separating operation should be added by selective proximal vagotomy, for ulcer disease of the stomach--by a parsimonious resection.     

Surgical tactics in postoperative eventration in children]

As a result of a clinical analysis of 66 observations on eventrations in children, the surgical tactics in this condition is founded. 38 experiments on dogs have shown that the maximal disorders of protein metabolism and transport occur on the 6th to 12th days, that is during the period of formation and maturation of the connective scar. On the grounds of the obtained findings the authors suggest to use wider albumins, plasma and erithrocytic mass for weak patients in preoperative and postoperative management.