Surgical treatment of pulmonary hydatid cysts in pediatric patients

Hydatid cyst is a zoonotic infection that is caused by Echinococcus granulosus and alveolaris, and that can result in endemics in rural regions. Infections caused by Echinococcus granulosus are more commonly seen in our country. In this retrospective study, we aimed at discussing the experience we have accumulated on pediatric pulmonary hydatid cyst cases over the last 6 years. Between 1995-2001, in the Department of Thoracic and Cardiovascular Surgery in Gaziantep University, 38 cases underwent 39 operations due to pulmonary and hepatic hydatid cysts. Of these, 24 were males and 14 were females, with an age range of 2-16 years. Operations were frequently performed via thoracotomy. Nineteen cysts were intact, and 26 were perforated. One case had sternotomy, another had sequential thoracotomy, and the rest of the cases underwent thoracotomy, which resulted in cystotomy-capitonnage. In the postoperative period, 2 patients had sustained air leakage, and 2 other cases developed skin infections. Average hospital stay was 5 days. After the operation, the patients received chemotherapy (albendazole 10 mg/kg/day) for 1.5 months. Early or late deaths or recurrences were not observed. We conclude that cystotomy-capitonnage is a successful treatment for pediatric pulmonary hydatid cysts, as it preserves the parenchyma. Chemotherapy in the postoperative period is beneficial in preventing the recurrences.     

微囊法棘球蚴继发感染小鼠动物模型的建立

目的 通过体外培养原头蚴发育成微囊,经腹腔注射建立稳定的细粒棘球蚴和多房棘球蚴继发感染小鼠动物模型。方法 无菌条件下采集羊源细粒棘球绦虫原头蚴和鼠源多房棘球绦虫原头蚴,经胃蛋白酶消化后检测虫体活力并计数,于37℃、5%CO₂条件下进行体外培养至发育成微囊,以每鼠50个微囊的剂量经腹腔注射的途径分别接种BALB/c小鼠。接种6个月后,通过腹部解剖大体观察和病理检测分析各组小鼠的感染情况及包虫囊的生长情况。结果 原头蚴在体外培养60d时发育成微囊,显微镜下观察Eg具有明显的透明角质层结构,而Em微囊角质层较薄。小鼠细粒棘球蚴和多房棘球蚴的感染率均为100%,Eg包虫囊为游离单囊,成囊率达70%,囊内无原头蚴;Em包虫囊为类似肿瘤的团块状组织,病灶内有生发囊及原头蚴。结论 采用微囊法可建立稳定的棘球蚴继发感染小鼠动物模型,为疫苗研制、药物筛选和疗效判定提供研究动物模型。     

Case Report: Primary Giant Splenic Echinococcal Cyst Treated by Laparoscopy

Cystic echinococcosis (CE) is a zoonosis caused by the larval stage of the dog tapeworm Echinococcus granulosus. Liver and lungs are the most commonly affected organs whereas splenic infection is rarer and its primary involvement occurs in less than 2% of abdominal CE. We report a case of primary giant splenic hydatid cyst in a 75-year-old Peruvian woman that was laparoscopically removed without any complications, perioperative prophylactic chemotherapy with albendazole 400 mg twice a day 5 days before, and 7 days after the surgical procedure was administered, postoperative recovery was uneventful, and; at her 3-month follow-up the patient remains asymptomatic and an abdominal computed tomography scan demonstrated a cystic cavity of 15 cm diameter with no daughter vesicles, neither other abdominal organ involvement. This case is in line with the existing literature on laparoscopical treatment of splenic cystic hydatid disease, suggesting that laparoscopical treatment is a safe and effective approach for large splenic hydatid cysts to be preferred to open surgical techniques.     

Study of cystic echinococcosis in slaughtered animals in Al Baha region, Saudi Arabia: Interaction between some biotic and abiotic factors

The variation in cystic echinococcosis (CE) prevalence and mean intensity was studied in relation to site, season and host age and sex. A total of 12,911 slaughtered animals, 140 camels, 2668 cattle, 6525 sheep and 3578 goats were inspected for hydatid cysts in Al Baha region, Saudi Arabia, in three study areas during four seasons from June 2008 to May 2009. The prevalence of infection was 32.85%, 8.28%, 12.61% and 6.56% in camels, cattle, sheep and goats respectively. The prevalence of the parasite varied significantly in relation to site, season and host age classes and sex in most host species. Spring showed the highest prevalence in camels, cattle and sheep. A significant association was found among host age classes and likelihood of infection in all examined hosts and the oldest age class was significantly more likely to be infected. The main effects in parasite intensity were host sex and age in most examined host species. A positive correlation was found between intensity of CE and host age class in all animal species examined. The most commonly infected organs were liver and lungs which constituted 48.75% and 32.83% respectively, of the total infected organs. There was a significant difference among host species in fertile cysts (P < 0.0001). The higher percentages of fertile cysts were in sheep (47.67%) and goats (23.99%) indicating that sheep and goats are the most important intermediate hosts for Echinococcus granulosus. Examined hydatid cysts of the liver had a higher fertility rate (38.79%) than those of the lungs (25.13%). Cysts size ranged from 1 to 8 cm in diameter. The mean cyst diameter was found in the lungs higher than that in the liver in all hosts. The range in the number of cysts was 1-33 in infected animals. The mean number of cysts was higher in lungs than that in liver in all examined animals. The viability rate of protoscoleces of liver fertile cysts (62.20%) was significantly higher than that of lung cysts (52.73%). In conclusion, these findings of infection, mean abundance and fertility rates of CE in slaughtered animals, prompt plans for further epidemiological studies and control programmes.     

Absence of brain involvement and factors related to positive serology in a prospective series of 61 cases with pulmonary hydatid disease

A prospective series of 65 patients with surgically confirmed lung cystic hydatid disease was evaluated in terms of their radiologic characteristics, serologic response, and presence of cysts in other organs. Cysts were mostly single and located in lower lung lobes. Liver compromise was found in 34% of the patients. Despite a systematic search, no patient showed brain cysts in this series. Twelve patients had previous hydatid disease: six in the liver and eight in the lung (two had involvement of both organs in the past). Serology using bovine cyst fluid in an immunoblot assay was 85% sensitive. Serologic response was not associated with number or cyst or compromise of other organs but was clearly associated to the presence of at least one complicated cyst. Cyst status in terms of complications should be described to allow appropriate assessment of serologic evaluations.     

Complications of extrahepatic echinococcosis：Fistulization of an adrenal hydatid cyst into the intestine

Echinococcal cysts are usually found in liver and lungs, but any other organ can potentially be involved. Extrahepatic disease due to hydatid cyst may develop in the abdominal and pelvic cavity, aside from in other less common locations, which may make both diagnosis and treatment more complex. We present a rare case of extrahepatic echinococcosis in a 70-year old patient with a 4-d history of dull abdominal pain, anemia within the transfusion range and fever. She underwent surgery for left renal hydatid cysts 30 years ago. After non operative treatment, imaging studies showed a calcified hydatid cyst in a retrogastric location communicating with a proximal jejunal loop. En-block resection of the mass together with the adrenal gland was performed including closure of the enteric fistula. Anatomic pathology confirmed the diagnosis of a calcified hydatid cyst of left adrenal origin. Surgery is the treatment of choice and most authors recommend removal of cyst and adrenal gland.     

Minimal access therapy in pediatric pulmonary hydatid cysts

Hydatid cysts occur commonly in lungs in the pediatric age group. Though medical management has been tried, definitive management of the condition is essentially surgical. Use of video-assisted thoracic surgery (VATS) has been rarely employed for the management of pulmonary hydatid cysts. We present a 10-year-old boy with pulmonary hydatid cysts treated with VATS-assisted minithoracotomy with hydatid cyst enucleation and capitonnage. The patient developed a lung abscess postoperatively and had to undergo lobectomy. The surgical management of pulmonary hydatid cysts is discussed here. The role of minimal access therapy for pulmonary hydatid cysts is highlighted.     

An extensive ultrasound and serologic study to investigate the prevalence of human cystic echinococcosis in northern Libya.

A prevalence study of abdominal cystic echinococcosis (CE) was undertaken in the northwest, north-central, and northeast regions of Libya. A total of 36 villages along the coast were included, in which 20,220 people were screened by portable ultrasound. Three hundred thirty-nine (1.7%) were diagnosed with CE. There was no significant difference between CE prevalence rates in the three regions of Libya (mean = 1.6%); however, intervillage rates were variable, ranging from 0% to 4.5%. The prevalence of CE increased significantly with age (P < 0.0001) and females were significantly more affected (2%) than males (1.3%) (P < 0.0001). Cases of CE were distributed among 3.2% of housewives, 2.6% of farmers, 2.3% of male civil servants, 1.3% of female students, and 1.1% of male students. Housewives (P < 0.0001) and students (P < 0.0001) were significantly more at risk for CE. A statistically significant proportion (62% [210 of 339]) of CE cases kept dogs (P < 0.0001). Of the ultrasound-positive CE cases 69% (233 of 339) were antibody seropositive by ELISA using Echinococcus granulosus hydatid cyst fluid antigen B. Blood samples (n = 10,096) collected onto filter papers were taken randomly from ultrasound-negative people who entered the study, of which 11.2% were found to be seropositive. Seropositivity increased with age (P < 0.0001), with females exhibiting higher seroprevalence than males for all age groups (P < 0.0001). Seroprevalence was distributed occupationally among 17.3% of female students, 11.2% of male students, 8.3% of housewives, 7.3% of farmers, and 6.4% of male civil servants. Housewives and students were more likely to be seropositive (P < 0.0001). Forty-seven percent (526) of the seroreactors kept dogs. All liver hydatid cysts detected by ultrasound during community screening were classified according to morphology and size into six types. Type I (17.5% of all cases) were small univesicular cysts less than 50 mm in diameter with no laminations or daughter cysts. Type II (34%) were univesicular cysts with only laminations. Type IIIa (8.5%) were univesicular cysts with the appearance of laminations and daughter cysts. Type IIIb (13%) were univesicular with laminations and less prominent daughter cysts. Type IV (5.6%) presented as a solid mass. Type V were degenerated calcified or partially calcified cysts (13.2%). Type VI presented as multiple cysts (8% of all cases). The CE cases that exhibited Types II, IIIa, IIIb, IV or VI cysts showed the highest seropositivity (86%, 96%, 95%, 100%, and 96%, respectively), while Types I and V were the least seroreactive (38% and 22%, respectively). Cases of CE occurred in 311 families, with 93% having only one member as a CE case while 7% of the families had two or more cases. However, 25% of the ultrasound-negative persons belonging to families with an index CE case were seropositive for antibodies to Echinococcus. These results confirm the importance of human CE in Libya. They also confirm the usefulness of ultrasound combined with serology as a mass screening approach for CE in north African communities.     

Percutaneous drainage of hydatid cyst of the liver: long-term results

BackgroundPreviously surgical operation was the only accepted treatment for hydatid liver cysts. Recently percutaneous management has become more preferable because of its low morbidity rate and lower cost.Patients and methodsIn all, 101 patients harbouring 120 hydatid cysts of the liver were treated by percutaneous drainage between October 1994 and December 1997. Of these cysts, 89 were in the right liver and 31 in the left liver.Thirty-one patients had had previous operations for hydatid disease. All cysts had an anechoic or hypoechoic unilocular appearance on ultrasound scan. The mean dimension of the cysts was 7.5±2.9 cm (range 3–10.4 cm). All patients received oral albendazole 10 mg/kg perioperatively. After aspiration under sonographic guidance, cysts were irrigated with 95% ethanol.ResultsThe amount of cyst fluid aspirated was 220±75 ml and the amount of irrigation solution used was 175±42 ml. Four patients developed mild fever and three had urticaria. Mean length of hospital stay was 2.1±0.7 (range 1–4) days, and patients were followed up for 43–62 months (mean 54±5.4 months). Maximal cyst diameter decreased from 7.5±2.9 cm to 3.2±15 cm (p<0.001). Sonographic examinations revealed high-level heterogeneous echoes in the cyst cavity (heterogeneous echo pattern), while the cyst cavity was completely obliterated by echogenic material (pseudotumour echo pattern).DiscussionMost hydatid cysts of the liver can be managed successfully by a combination of drug therapy and percutaneous drainage.     

Hydatid disease of the spine: A survey study from Turkey

Summary Spinal hydatid disease is rare, even in rural areas where echinococcosis is endemic. Although the liver and lungs are commonly involved, spinal hydatid disease, either primary or secondary, represents an uncommon but significant manifestation of the disease. This survey study reviews 28 reports of spinal hydatid disease from Turkey during the past 5 decades. Only 14 patients also had pulmonary or some other organ infestation. The cysts affecting the spine were commonly in the thoracic region. Most patients had intraspinal extradural hydatid cysts associated with vertebral involvement. The presenting symptoms were mostly atypical, and it was interesting that most of the patients were misdiagnosed preoperatively as Pott's disease during the first decades, suggesting that new imaging techniques such as CT and MRI are the diagnostic procedures of choice for this disease. Surgery remains the best therapy for spinal hydatid disease, although adjuvant antihelminthic therapy may be necessary. There were only 15 cases of recurrence (18%); surgical intervention was palliative in all these patients and it was followed by chemotherapy. Operative mortality was very low (two patients died in the early postoperative period) and there were no complications related to treatment with antihelminthic drugs. The study indicates that hydatid disease should be considered in the differential diagnosis when radiological findings suggest spinal infections or tumors, and that surgical decompression in association with chemotherapy is the treatment of choice.     

Videolaparoscopic treatment of hepatic hydatid cyst

BACKGROUND/AIMS: Unroofing, cystopericystectomy, or cystic evaluation and omentoplasty have been used in videolaparoscopic treatment in hepatic hydatidosis since 1992. Currently it is shown that videolaparoscopic treatment has been carried out successfully in selected cases. METHODOLOGY: Fifteen hepatic hydatid cysts in 12 cases were treated by videolaparoscopic methods. Formerly in the 5 cases, the cysts were aspirated with a needle designed for a 5-mm trocar, leaving a cystic cavity that was tension-free, then scolicidal solution was injected and aspirated. In the last 7 patients an aspirator-grinder apparatus was used. Intraoperative ultrasonography was applied in all patients. RESULTS: All the cysts were treated by drainage and omentoplasty. In one case cystic cavity infection was diagnosed in the 2nd postoperative month (morbidity rate 8.33%). Another patient died due to cerebral hydatid cyst and multiple organ failure after the postoperative first month (mortality rate 8.33%). Operative mortality was not seen. CONCLUSIONS: Videolaparoscopic treatments of hepatic hydatid cysts may be carried out successfully in selected cases.     

Case Report: Immunological Characteristics of Recurrent Echinococcosis-Induced Anaphylactic Shock

Anaphylactic shock represents a serious complication of echinococcosis as up to 4.6% of patients die as a result of its severity and improper handling. Once a definite diagnosis is made, effective treatments need to be immediately initiated. Here, we report the immunological characteristics and management of two patients with recurrent anaphylactic shock concurrent with the surgical removal of hydatid cysts. Both patients had systemic echinococcosis classified as cystic echinococcosis type 2 (CE2) with multiple, immature cysts (absence of calcification and necrosis). In addition, both patients had increased eosinophils and basophils before surgery, as well as elevated crude hydatid cyst fluid antigen (anti-EgCF) and hydatid cyst fluid native antigen B (anti-EgB) antibodies and high IgG levels. Although we cannot definitively predict which patients are at risk for cyst fluid leakage or anaphylactic shock at present, clinicians may consider taking precautions before surgery on encountering patients with a similar profile to prevent the occurrence of anaphylactic shock and the likelihood of a second incident. However, these observations need to be confirmed in further studies with a larger number of patients.     

Intraperitoneal rupture of the hydatid cyst: Four case reports and literature review

BACKGROUND Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons.However, some patients develop symptoms and complications due to cyst size,location, and the relationship between the cyst and adjacent structures. The most serious complications that can occur are rupture of the cysts into the biliary tract,vascular structures, hollow viscus, and peritoneal cavity. We aimed to describe the management of four cases of intraperitoneal rupture of hydatid cysts.CASE SUMMARIES Four patients aged between 27 and 44 years(two men and two women) were admitted to our clinic with sudden abdominal pain(n = 4), hypotension(n = 3),and anaphylaxis(n = 2). Three of the perforated cysts were located in the liver,and one was located in the spleen. Two patients developed cyst rupture after minor trauma, and the other two developed spontaneous rupture. Enzymelinked immunosorbent assay IgG results were positive for two patients and negative for the other two. All patients received albendazole treatment after surgical intervention(range: 2-6 mo). Two patients developed hepatic abscesses requiring drainage; one of these patients also developed hydatid cyst recurrence during postoperative follow-up(range: 25-80 mo).CONCLUSION Intraperitoneal rupture is a life-threatening complication of hydatid cysts. It is important to manage patients with surgical intervention as soon as possible with aggressive medical treatment for anaphylactic reactions.     

Surgical treatment of hydatid cyst of the lung: review of 30 cases.

Hydatid cyst disease is still a problem in Turkey, especially in the east Anatolian region, as well as in many other places in the world. A retrospective review was made of the surgical treatment of 30 patients with pulmonary hydatid cysts during the last 3 yrs. Nineteen patients were male and 11 female with an average age of 23.5 yrs (range 4-44 yrs). Cystotomy and capitonnage were performed in 28 of the 30 cases (93.4%). The transdiaphragmatic route or simultaneous laparotomy was preferred when the liver was involved. Albendazole was used in four patients with multiple hydatid cyst due to probable recurrence in the postoperative period. Cough and chest pain were the prominent symptoms in the majority of cases. A single lobe was affected in 22 patients. Unilateral multiple foci were present in four patients and bilateral multiple foci in four. Six patients had concomitant liver cysts. Morbidity was low and no mortality was seen. No recurrences were seen on control chest radiographs during the last 2-yr follow-up. In the treatment of hydatid cyst of the lung, conservative surgical methods such as cystotomy and capitonnage still remain the treatment of choice. Medical treatment could be used for prophylactic purposes and in some instances, but the percutaneous aspiration method should not be performed.     

Review of cases with cystic hydatid lung disease in a tertiary referral hospital located in an endemic region: a 10 years' experience

BACKGROUND: Echinococcus disease is endemic in sheep-and cattle-raising areas world wide. Its prevalence is also high in the Mediterranean region including Turkey. OBJECTIVE: To determine the presentation, approach to surgical treatment and outcome of hydatid disease in an endemic region. METHODS: From January 1989 to December 1998 288 patients, aged between 1 and 71 years with a mean age of 31 years (134 female, 154 male), were operated on for pulmonary hydatidosis. Clinical charts of the patients were reviewed retrospectively in a tertiary referral hospital. RESULTS: Of 288 patients, 30 patients were asymptomatic, the rest (89%) were symptomatic, cough and chest pain being the most common symptoms. Fifty-three patients (18%) had associated liver hydatid cysts. Bilateral lung hydatid cysts were present in 18 patients (6%). Recurrent hydatid cysts were observed in 33 patients (11%). Seventy-seven patients (27%) presented with complicated hydatid cysts. Postoperative morbidity was observed in 3 patients [bronchopleural fistula (2), infection of the cyst space (1)] and postoperative mortality in 1 patient who presented with hydatid lung disease associated with liver and brain cysts. In the remaining 98. 6%, no complications were noted. CONCLUSIONS: In conclusion, hydatidosis is still an important public health problem in Turkey and in an endemic country such as Turkey hydatid lung disease should be considered initially in a patient presenting with a corresponding chest roentgenogram and a compatible epidemiologic history. Surgery is indicated in all symptomatic and/or enlarging or infected cysts. When necessary lobectomy or wedge resection can be the procedure of choice. Single-stage combined resection is preferred in hydatid lung disease with associated liver hydatid cysts. Total postoperative complication and mortality rate is low and we recommend a close follow-up of the operated cases to diagnose postoperative recurrence early in its course.     

A new percutaneous approach for the treatment of hydatid cysts of the liver

OBJECTIVES: The aims of this study were to investigate the efficacy of a new percutaneous treatment modality of hydatid disease of the liver and to present the results of long term follow-up. METHODS: Eighty-seven patients (55 female, mean age 43.5 yr) with 98 hydatid cysts (73 type I, 15 type II, and 10 type III) in the liver underwent percutaneous treatment. All patients were examined by ultrasonography and some of them were examined by CT. They were all positive by indirect hemagglutination test. Sonographic guidance was used in all patients. The procedure included the puncture and free drainage of the cyst fluid. After free drainage was stopped, absolute alcohol and polidocanol 1% were used as sclerosing agents. The patients were followed-up with periodic ultrasonographic examinations. RESULTS: The mean follow-up time was 33 months. The mean diameter of the cysts decreased from 77.0+/-2.7 mm to 63.0+/-2.5 mm (p < 0.001). The entire cyst cavity filled with a solid echo pattern in 32 cysts, two-thirds of the cyst cavity showed a pseudotumor echo pattern in 34 cysts, and one-third of the cyst cavity showed a pseudotumor pattern in 23 cysts, whereas no pseudotumor appearence was observed in eight cysts. Apart from an anaphylactoid reaction observed in one patient, no major complication occurred during the follow-up period. CONCLUSIONS: Long term results indicate that this new percutaneous treatment modality of the hydatid disease of the liver is an effective and safe method without causing major complications. Percutaneous treatment of hydatid cysts of the liver offers good results and should be the first choice, especially for patients who are contraindicated to surgery.     

手术治疗邻近肝门部肝细粒棘球蚴病效果观察

目的 探讨手术治疗邻近肝门部的肝细粒棘球蚴病的效果。方法 回顾性分析2015年 11月至 2019年1月行外囊完整剥除术、外囊次全切除术及内囊摘除术的 20例共36个邻近肝门部的肝棘球蚴囊肿的手术疗效。结果 4个肝棘球蚴囊肿成功行外囊完整剥除术,30个肝棘球蚴囊肿成功行外囊次全切除术,2个肝棘球蚴囊肿因外囊与肝门血管粘连过于紧密且已经破裂入胆道而行内囊摘除术。肝门部大血管均保存完整,除1例因术前肝棘球蚴囊肿破裂入胆道(行内囊摘除术)而出现术后胆漏以外,余均无残腔并发症发生。结论 对于邻近肝门部的肝细粒棘球蚴病的手术治疗,外囊次全切除术与外囊完整剥除术较传统的内囊摘除术,术后胆漏、残腔感染等并发症发生率相对较低,可优先选择。但是还应根据囊肿的部位、大小及手术中具体情况选择具体的手术方式。     

A new therapeutic approach for treatment of hydatid cysts of the spleen

The aims of this study were to investigate the efficacy of a new percutaneous treatment of hydatid cysts of the spleen and to present the results of long-term follow-up. Nine patients (six men, three women; median age 37 years) with 10 hydatid cysts in the spleen underwent a new percutaneous treatment. The procedure included the puncture and free drainage of the cyst fluid under sonographic guidance. After drainage has stopped, alcohol 96% and polidocanol 1% were used as sclerosing agents. The patients were followed up with periodic sonographic examinations. The median follow-up period was 39 months (range: 6–64 months). The median diameter of the cysts decreased from 63.0 mm to 33.3 mm (P < 0.01). The entire cyst cavity filled with a solid echo pattern in three cysts, two thirds of the cyst cavity showed a pseudotumor pattern in three cysts, and one third of the cyst cavity showed a pseudotumor pattern in four cysts. Apart from an urticarial reaction, no major complications occurred during the follow-up period. One patient had under-gone splenectomy due to persistent left upper quadrant pain eight months after treatment. Long-term results indicate that this new treatment modality of splenic hydatidosis is an effective and safe method and causes no major complications.     

Comparison of serological and clinical findings in Turkish patients with cystic echinococcosis

Summary Cystic echinococcosis (CE), caused by the cestode Echinococcus granulosus, is potentially dangerous for humans. The aim of this study was to examine serological and clinical findings regarding cysts localisation and individual responses in 54 patients with CE. The majority of patients in this study were females (63 %) and the average age was 46.3 years. Most of the patients lived in rural areas or kept a dog (46 %) for a long time. The most frequent symptoms were hypochondrial pain (48.9 %), epigastrial discomfort (27.7 %), vomiting (21.3 %), minor cough (12.8 %), urticaria (6.3 %), weakness (4.3 %), fever (2.1 %), side-or back-ache (4.3 %). However, 17 % of the patients showed no symptoms. In every case, the ultrasound (USG) and/or computer tomography (CT) investigations were positive. In most cases (53.2 % of the patients) a single cyst was found but 46.8 % of the patients had multiple cyst formations (from 2 to 9 cysts) located in the liver. Sporadic lung, splenetic, mesenterial, tibial and cerebral localisations were also found. The patients were individually treated with albendazol (10–15 mg/kg) five days prior and six months after the surgical treatment. Serum samples were investigated by the serological techniques: IHAT, ELISA and Western blot using hydatid fluid antigen. In the patient sera, the specific antibody levels were mostly increased after surgery. Different results were obtained only in two patients. In the first case, seroconversion was delayed. In the other case all ELISA results were negative, however, the Western blot analysis and surgery proved the presence of CE. The results suggest that the different antibody response of patients depends on the individual immune response. Multiple localization and various stages of CE cysts demonstrate the necessity of a complex approach for the confirmation of a correct diagnosis.     

Controversies in the laparoscopic treatment of hepatic hydatid disease

BackgroundLaparoscopic treatment of hydatid disease of the liver can be performed safely in selected patients.MethodsSix hundred and fifty patients were treated for hydatid disease of the liver between 1980 and 2003 at the Hepatopancreatobiliary Surgery Unit of Istanbul Medical Faculty, Istanbul University. Of these, 60 were treated laparoscopically between 1992 and 2000. A special aspirator-grinder apparatus was used for the evacuation of cyst contents. Ninety-two percent of the cysts were at stages I, II or III according to the ultrasonographic classification of Gharbi.ResultsConversion to open surgery was necessary in eight patients due to intra-abdominal adhesions or cysts in difficult locations. There was no disease- or procedure-related mortality. Most of the complications were related to cavity infections (13.5%) and external biliary fistulas (11.5%) resulting from communications between the cysts and the biliary tree. There were two recurrences in a follow-up period ranging between 3.5 and 11 years.DiscussionLaparoscopic treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. Our specially designed aspirator-grinder apparatus was safely used to evacuate the cyst contents without causing any spillage. Knowledge of the relationship of the cyst with the biliary tree is essential in choosing the appropriate patients for the laparoscopic technique. In our experience of 650 cases, the biliary communication rate was as high as 18%; half of these can be detected preoperatively. In the remaining, biliary communications are usually detected during or after surgery. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy are helpful to overcome this problem. As hydatid disease of the liver is a benign and potentially recurrent disease, we advocate the use of conservative techniques in both laparoscopic and open operations.