Comparative characteristics of nonparasitic and opisthorchiasis cysts of the liver

The authors observed 24 patients with opisthorchiasis and 14--with nonparasitic cysts of the liver. No essential differences in the tactics of surgical treatment of these cysts were noted. In medium-size and large cysts, the operative treatment--excision of cystic walls with omentoplasty, liver resection--is recommended; in small opisthorchiasis and nonparasitic cysts--dynamic observation with the performance of ultrasound scanning.     

Opisthorchiasis of the liver]

The authors discuss 34 patients with opisthorchiasis cysts of the liver, 17 of them were treated by operation. The disease is not a rare occurrence in endemic foci. Ultrasonography is considered to be the most informative method in the diagnosis of opisthorchiasis hepatic cysts. Patients with cysts of moderate and large size (more than 5 cm) are subjected to surgery. Those with cysts of a small diameter are kept under dynamic observation. It is claimed that in untreated opisthorchiasis additional drainage of the biliary tract during the operation is expedient. Opisthorchiasis cysts of the liver possess characteristic morphological signs; the wall of the cyst is usually formed by the walls of the distended bile ducts with marked adenomatous growths of the epithelium. The authors show the late-term results of surgery in follow-up periods of 2 to 11 years, which they claim to be quite satisfactory.     

Outcomes of injuries of the liver and gallbladder in patients with opisthorchiasis

The authors had 10 patients with isolated injury to the gallbladder and 51 patients with injury to the liver in coexistent opisthorchiasis. An emergency operation was undertaken in all of them. The structural changes of the hepatobiliary system in chronic opisthorchiasis in man and the intraductal biliary hypertension induced by them form a morphofunctional complex which promotes the escape of bile and the development of the biliary peritonitis even in mild injury to the liver. Cholecystectomy in indicated in isolated injuries to the gallbladder. Decompression of the biliary tract and drainage of the abdominal cavity are necessary for the prevention of biliary peritonitis in the postoperative period in patients with opisthorchiasis. The total mortality was 17.6%.     

Surgical management and long-term outcome of complicated liver hydatid cysts caused by Echinococcus granulosus

BACKGROUND: The aim of this retrospective study was to evaluate clinical presentation and long-term outcome of patients treated surgically for complicated liver hydatid cysts. PATIENTS AND METHODS: Eighty-four patients with liver hydatid cysts underwent an operation at the Geneva University Hospital between 1980 and 1999. Clinical presentation, postoperative morbidity, mortality, and long-term recurrence rate were evaluated. RESULTS: Among the 84 patients with liver hydatid disease, 35 patients (41%) presented complicated cysts (ie, cysts that had developed a fistula into adjacent structures or organs). In most patients, the fistula communicated with the biliary tree (n = 25), but we also observed communication with the right lung (n = 3), the right diaphragm (n = 2), liver parenchyma (n = 1), and peritoneal cavity (n = 1). Complete removal of the cystic disease was possible in 24 of 35 patients (70%). In 11 patients, fragments of cysts were not removed because of their location adjacent to main vessels. Postoperatively, 8 patients (23%) developed a severe complication (grade II and III). There were no postoperative deaths, and no recurrences of hydatid disease were observed with a median follow-up of 8.6 years (complete follow-up was obtained in 69% of patients). CONCLUSIONS: Complicated liver hydatid disease is frequent and was observed in almost half of patients operated for liver hydatid cysts at our center. Using a surgical strategy aimed at complete removal of cystic and pericystic tissue with simultaneous treatment of the fistulous tract, we observed 23% postoperative morbidity, no mortality, and no recurrence of disease with a median follow-up of >8 years.     

Treatment of large echinococcal cysts of the lungs

An analysis of 177 operations for pulmonary echinococcosis performed in 160 patients has been made (17 patient were operated twice because of bilateral localization of the cysts). For patients with large and giant cysts the author prefers organ-preserving operations, the A. A. Vishnevski method being considered the best. There were 115 such operations. Among other organ-preserving operations there were: 12 operations by the method of Bobrov - Spasokukotski , 16 operations of different variants of capitonage , 15 combinations of organ-preserving operations, 5 one-step operations on the lungs and liver and only 10 operations of various resections of lungs. In the rest 4 patients other operations were performed. Postoperative lethality was 2,2%. A stable clinical effect with a complete recovery was noted in 87 of the patients examined in a remote postoperative period. Two patients had recurrences of the disease.     

The possibilities of surgical treatment of hepatocellular cancer in patients with liver cirrhosis

154 radical liver resections were performed on the reason of the hepatocellular cancer, of them 33% in patients with liver cirrhosis. Liver function was assessed using the Child--Pugh score. Liver cirrhosis and extensive liver resections proved to be the independent complication and lethality risk factors. The extensive liver resections were performed in 70%. The postoperative morbidity rate was 44.8%, the lethality was 5.8%. The concomitant liver cirrhosis reliably worsens postoperative complications (p = 0.001) and lethality (p = 0.0001) rates. The long-term treatment results were analyzed. Thus, liver resection proved to be an appropriate treatment for patients with hepatocellular cancer and liver cirrhosis Child--Pugh stage A, but a thorough patient selection is recommended. Liver resection is contraindicated by liver cirrhosis Child--Pugh stage B. The orthotopic liver transplantation is recommended in such cases, considering that Milan criteria are observed. The rest cases should consider the possibilities of radiofrequency ablation, transarterial chemoembolization, chemotherapy.     

Treatment of hydatid echinococcosis of liver

Experience of surgical treatment of 373 patients with echinococcosis of liver is analyzed. Traditional surgeries were performed in 342 patients. Postoperative lethality was 1.46%, number of specific postoperative complications -- 12.5%. In long-term period recurrence was revealed in 18 (6.8%) of 264 examined patients. In 9 years after surgery residual cavities were diagnosed in 33 (9.64%) patients. Recovery was achieved in 93% patients. Experience of treatment of 31 patients with echinococcosis of liver with puncture methods (PAIR, PEVAC) was also analyzed. There were no lethal outcomes, severe complications and recurrences of disease during 2 years of follow-up. It is concluded that puncture method may be regarded as alternative for traditional surgical treatment, but it require further study.     

Surgical management of complicated hydatid cysts of the liver

AIM: To review the clinical presentation and surgical management of complicated hydatid cysts of the liver and to assess whether conservative surgery is adequate in the management of complicated hydatid cysts of liver.METHODS: The study was carried out at Sher-i-Kashmir Institute of Medical Science, Srinagar, Kashmir, India. Sixty nine patients with hydatid disease of the liver were surgically managed from April 2004 to October 2005 with a follow up period of three years. It included 27 men and 42 women with a median age of 35 years. An abdominal ultrasound, computed tomography and serology established diagnosis. Patients with jaundice and high suspicion of intrabiliary rupture were subjected to preoperative endoscopic retrograde cholangiography. Cysts with infection, rupture into the biliary tract and peritoneal cavity were categorized as complicated cysts. Eighteen patients (26%) had complicated cysts and formed the basis for this study.RESULTS: Common complications were infection (14%), intrabiliary rupture (9%) and intraperitoneal rupture (3%). All the patients with infected cysts presented with pain and fever. All the patients with intrabiliary rupture had jaundice, while only four with intrabiliary rupture had pain and only two had fever. Surgical procedures performed in complicated cysts were: infection-omentoplasty in three and external drainage in seven; intrabiliary rupture-omentoplasty in two and internal drainage in four patients. Two patients with intraperitoneal rupture underwent external drainage. There was no mortality. The postoperative morbidity was 50% in complicated cysts and 16% in uncomplicated cysts.CONCLUSION: Complicated hydatid cyst of the liver can be successfully managed surgically with good long term results.     

The surgical management of congenital liver cysts

BACKGROUND: Most series that report the results of surgical treatment for congenital liver cysts focus more on the technical aspects of the operation than on the late outcome of these patients. In this paper, we emphasize the importance of appropriate patient selection and adequate surgical technique for successful long-term outcome. METHODS: Twenty-four consecutive patients with congenital liver cysts were selected for surgical treatment. According to our own classification, 13 patients had simple liver cysts, nine had multicystic liver disease, and two had type I polycystic liver disease. All of these patients were treated by the fenestration technique. An open approach was used for five patients (group 1) treated between 1984 and 1990. In 19 patients (group 2) treated since 1991, a laparoscopic approach was used. The incidence of complicated liver cysts was 40% in group 1 and 68% in group 2. RESULTS: There were no treatment-related deaths in this series. The mean postoperative hospital stay was significantly shorter for patients who underwent successful laparoscopic fenestration (p < 0.05). In the open group (group 1), there were no postoperative complications, and all patients were alive and free of symptoms during a mean follow-up of 130 months, without any sign of cyst recurrence. In the laparoscopic group (group 2), four patients were converted to open surgery. One of these patients had an inaccessible posterior cyst; another had bile within the cystic cavity. A further two cases had complicated liver cysts with an uncertain diagnosis between congenital and neoplastic cysts. Four patients (21%) developed peri- or postoperative complications. During a mean follow-up time of 38.5 months, none of the patients with simple liver cysts incurred late symptoms or signs of cyst recurrence. In the six patients with multicystic liver disease, one developed disease-related cyst progression (17%) and required reoperation. One of the two patients with type I polycystic liver disease (50%) developed asymptomatic disease-related cyst progression. CONCLUSIONS: When patients are carefully selected and a proper surgical technique is employed, excellent long-term results with a low morbidity rate can be achieved in patients with congenital liver cysts. Patients with multicystic liver disease or type I polycystic liver disease are more prone to late cyst recurrence. A tailored approach is thus indicated for patients with congenital liver cystic disease. However, the laparoscopic approach appears to be the gold standard for the treatment of highly symptomatic or complicated simple liver cysts.     

Prophylactics and treatment of complications after resection of the liver

Results of treatment of 147 patients with focal diseases of the liver are described. Postoperative complications appeared in 25.8%, postoperative lethality was 6.7%. Among the postoperative complications the leading role belongs to hepatic insufficiency. Prognostic factors of the development of postresectional hepatic insufficiency are the degree of liver cirrhosis and dilatation of the portal vein, malignant character of the tumor, volume of liver resection, whole protein level before operation. The strategy of mini-invasive treatment of patients with biliary complications was worked out. Strict selection of patients, using blood-saving methods and techniques allow postoperative lethality to be decreased.     

Endoscopic retrograde cholangiography for intrabiliary rupture of hydatid cyst

BACKGROUND: Hydatid disease affects most commonly the liver, and rupture into the bile ducts is a frequent complication, occurring in 5% to 25% of cases. These complications can cause major clinical problems either preoperatively or postoperatively with post-resectional abscess or prolonged biliary fistula. We reviewed our experience with preoperative endoscopic retrograde cholangiography (ERC) and the diagnosis of major cyst-biliary fistula. METHODS: During a 7-year period, 78 patients underwent surgery for hepatic hydatid disease. Ten patients, in whom a major intrabiliary rupture of the cyst was suspected on the basis of clinical and radiological criteria, underwent preoperative ERC, with clearing of the biliary tree. Endoscopic sphincterotomy was performed in 7 cases when the fluid contained daughter cysts or pus. Three patients, in whom the biliary content was fluid only, did not undergo sphincterotomy. One patient in whom a preoperative ERC was not feasible underwent operative transduodenal sphincterotomy. In all 11 patients the cyst was resected. Two patients underwent preoperative ERC, but no fistula was detected .They were compared with the remaining group of 67 patients who underwent resectional surgery during the same period, for apparently uncomplicated echinococcal cysts, and with an historical group of 569 patients operated on from January 1966 to January 1995. RESULTS: According to the clinical and radiological preoperative criteria, there were 2 false positives. Preoperative ERC allowed visualization of the fistula, clearing of the biliary tree, and sphincterotomy in selected cases. The incidence of postoperative fistula was significantly decreased after the introduction of selective preoperative ERC, on the basis of preoperative clinical and radiological criteria. CONCLUSIONS: Preoperative ERC is very helpful in patients with cyst-biliary fistula, allowing visualization of the fistula and drainage of the biliary tree, and reducing the incidence of postoperative complications from 11.1% to 7.6%. In selected cases it can solve the problem, without further surgical therapy.     

A Case of Ulcerative Colitis with Peristomal Pyoderma Gangrenosum

Background:  A regenerative function is in one of the functions of liver, and if it is a normal liver, it will reproduce even to capacity almost before an operation within one year after excision. However, liver substance is pressed over the long period of time, and, as for liver cysts, a postoperative liver reproduction process is unknown. Comparison examination of the multiple liver cysts postoperative liver reproduction was carried out with after the operation.
Patients:  It was aimed at one example of a multiple liver cysts operation and three metastatic live tumor (two extended left lobectomy, one right lobectomy) in this hospital. Liver volume was measured before an operation and 14 postoperative days CT, and comparison examination of the standard liver volume ratio called for from height weight was carried out.
Results:  Before an operation of liver cysts and 14 postoperative day, liver volume was 151% 45 or 69% in 450 or 680 ml. Before an operation of control group and day 14 postoperative day liver volume was an average of 128% at 116 and 128 or 140% in 62, 72, 56, 71, and 49 or 68% at 618, 720, 532, 680, and 516 or 720 ml, respectively.
Conclusion:  Multiple liver cysts postoperative liver reproduction was promoted compared with after the liver resection.     

A comparative analysis of the laparotomy and puncture-drainage methods of treatment in unformed postnecrotic cysts of the pancreas

The authors share their experiences with treatment of 94 patients with unformed pancreatic cysts. In 55 of them the laparotomy method of treatment (external drainage, sequestrectomy) was used after which in 14.5% of the cases postoperative complications developed, and the average time of staying at the hospital was 36 bed-days. In 1997-1998 the puncture-drainage method under USI control was used in 37 patients with the disease in question. It proved to be effective in 83.7% of the patients with the absence of large sequesters in the cyst cavities. This method allowed the number of complications and lethality to be decreased, the period of staying at the hospital being 47.2% shorter.     

Comparison between pulmonary and hepatopulmonary hydatidosis.

OBJECTIVES: To compare the clinical features and the surgical approaches between single pulmonary (SPH) and hepatopulmonary hydatidosis (HPH). METHODS: The hospital and follow-up records of 141 patients who had undergone surgery for pulmonary hydatidosis in our clinic between January 1991 and January 2001 were reviewed. Forty-nine patients (34.8%) had concomitant liver cysts in addition to the pulmonary cysts and they were regarded as HPH (Group I). The remaining 92 (65.2%) patients had SPH (Group II). Both groups were compared according to their clinical, radiological and surgical features. RESULTS: Seventeen (34.7%) male and 32 (65.3%) female patients had HPH. The mean age of the patients with HPH was significantly higher than the age of those with SPH (P<0.05) and the frequency of hepatopulmonary localization, which is contrary to single pulmonary cyst, was significantly higher in females (P<0.05). The majority (67.3%) of the cysts located in the liver were solitary. Multiple pulmonary cysts were in higher ratio in Group II, compared to Group I (45.7 vs. 22.8%) and bilateral pulmonary cyst ratio was higher in Group II, as well (26.5 vs. 13%) (P<0.05). In 14 patients (28.6%), the concomitant cysts localized in the dome of liver were extirpated via right thoracophrenotomy, and in one of them sternophrenotomy was performed. There was no statistically significant difference associated with the postoperative complications and hospital stay between groups. No recurrence and mortality were recorded in Group II. CONCLUSIONS: Multi-organ localizations (especially liver) should be examined in all patients with pulmonary hydatid cysts. HPH is more frequent in female patients over 40 years of age. The pulmonary cysts in HPH show a tendency to be bilateral and multiple. HPH should be regarded as a different entity since it can cause either economic or labour loss due to the multi-operations and prolonged postoperative care. The operative strategy and approach should be different in hepatopulmonary cysts especially if they locate in the right or bilateral lung. One-session operation with the improvements of its techniques and methods should be considered in selected cases.     

Combined operations with resection of the colon for locally disseminated stomach cancer

The 20-year experience with performance of combined interventions for locally spread gastric cancer is summarized. Resection of the stomach and colon was performed in 29 patients, gastrectomy with resection of the transverse colon--in 28, gastrectomy with the variants of hemicolectomy--in 5. There were 19 radical operations, and 43 palliative ones. Gross invasion of gastric tumour into the colon was revealed in 36 patients. Of them in 19, it was histologically confirmed. The postoperative complications were noted in 19.3%, the postoperative lethality was 9.7%.     

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.     

Diagnosis and treatment of complicated postnecrotic cysts of pancreas

Experience of complex treatment of 137 patients with complicated postnecrotic pancreatic cysts (PPC) is analyzed. Indications to different surgical methods are formulated differentially depending on complications of cysts, localization, sizes, "maturity" of cyst walls, communication with main pancreatic duct. Treatment of festered PPC should be started with minimally-invasive methods; at negative result the omentobursocystostomy with staged endoscopic sanations should be done that permits to decrease the number of postoperative complications and to reduce lethality from 14.3 to 4.5%. Resection of pancreas along with cyst is the operation of choice at pancreatic cysts complicated with bleeding; lethality has been reduced from 28.6 to 5.6%. Perforation of cysts into abdominal cavity is the indication to omentobursocystostomy with staged sanations of omental bursa, perforation into pleural cavity -- to distal resection of pancreas.     

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.     

One-stage operation via median sternotomy and phrenotomy for bilateral lung and liver hydatid disease

Background Echinoccosis is an endemic disease throughout the world. We reviewed a series of 26 bilateral lung and liver hydatid treated surgically via median sternotomy and either phrenotomy or laparotomy. Aims This study was conducted to emphasize the importance of one-stage operation via median sternotomy for multiple hydatid cysts. Materials and Methods This study is a retrospective review of our surgical skills for treatment of hydatid cysts. From January 1990 to January 2001, 173 patients were operated for hydatid disease in Heybeliada Thoracic Surgery Center. Twenty-six (15%) of them had bilateral lung hydatid cysts including 17 concomitant liver cysts. Median sternotomy was performed in all of 26 cases and phrenotomy was commonly used to remove concomitant liver cysts at the same operation. Cystotomy without capitonnage was the most common operative procedure for both lung and liver cysts. Results There was no operative and postoperative death. Post-operative complications occurred in only two patients: these were atelectasis and wound infection. The mean follow-up was 7.3 years (ranging from 1 to 12 years). No recurrence was recorded both in lung and in liver. Conclusions One-stage operation using median sternotomy and phrenotomy should be preferred to stage thoracotomies in suitable cases with multiple hydatid cysts. Cystotomy without capitomage and closure of the bronchial openings can be an alternative procedure in hydatid disease surgery. Albendozole treatment is necessary in the postoperative period to obtain good results without any recurrence.     

经腹腔镜治疗肝囊肿临床探讨

目的　探讨经腹腔镜手术治疗肝囊肿的临床价值。方法　对 3 4例不同部位及不同囊肿个数的肝囊肿进行腹腔镜手术治疗。结果　 3 4例病人中有 3 2例手术成功 ,4例行囊肿切除 ,2 8例行囊肿开窗引流术 ,2例中转开腹 ,手术时间 2 0～ 90min ,平均约 40min ,全部病人痊愈出院 ,2例多囊肝术后复发。结论　腹腔镜治疗肝囊肿是安全可行的 ,同时具有创伤小、恢复快等优点