Surgical tactics in associated echinococcosis of the liver and lung]

Over 10 years operations were conducted in 28 patients with hydatid disease with concurrent involvement of the liver and lungs, which accounted for 5.76% of all patients with hydatid disease of the thoracic and abdominal organs. The following variants were encountered: uncomplicated echinococcosis of the right lung and right hepatic lobe (13 patients); uncomplicated echinococcosis of the left lung and liver (3); suppurative hydatid cyst of the liver with rupture into the pleural cavity and the development of pyothorax (9); rupture of a hepatic hydatid cyst into the bronchial tree of the right lung with the development of a cysto-bronchial fistula (3 patients). In the group of 28 patients with concurrent involvement of the liver and lung 18 were operated on through a thoraco-phreno-laparotomic approach, 9 through a transpleural approach, and one patient underwent a two-stage operation. The success of the treatment is determined by early recognition of the concurrent echinococcosis and the choice of the optimal surgical tactics. One-stage echinococcotomy from the liver and lung is the operation of choice in concurrent affection of the liver and right lung.     

The recurrent lung hydatid cysts in children

The treatment results of 199 children with lung echinococcosis was performed. 78 (39.2%) had complicated forms of the disease. The organ-preserving operations were predominately performed: traditional echinococcectomy in 177 (89%) and videothoracoscopic echinococcectomy in 15 (7.5%). Lobe resection was performed in 2 patients. 5 patients cured without surgery thank to bronchial cyst evacuation. The long-term follow-up data were obtained from 163 (82%) of patients. Reccurense of the hydatid disease was registered in 8 (4.9%) patients. The study demonstrated the importance of immediate surgery after the cyst rupture with pleural dissemination and early recurrence diagnostics, which allows conservative treatment.     

非典型CE1型肝囊型包虫病的诊断及腹腔镜治疗体会

目的:探讨非典型CE1型肝囊型包虫病的有效诊断方法及腹腔镜手术的临床疗效。方法:回顾性分析2018年6月至2019年6月新疆维吾尔自治区人民医院收治的17例非典型CE1型肝囊型包虫患者临床资料,其中男性11例,女性6例,年龄(46.0±21.6)岁,均有畜牧区接触史。术前完善包虫免疫实验、腹部超声、腹部CT检查,行腹腔...     

Single-stage transthoracic approach for right lung and liver hydatid disease

OBJECTIVE: Human echinococcosis remains a serious health problem for the Mediterranean countries. Synchronous pulmonary and hepatic hydatid disease may occur in 4% to 25% of cases. Our experience on simultaneous surgical treatment of right lung and liver hydatid disease in patients was reviewed. METHODS: Between 1990 and 2000, 48 patients (33 female patients and 15 male patients) with synchronous right lung and liver dome hydatid cysts were operated with a 1-stage procedure. RESULTS: Six patients had previous surgical treatment of hepatic (n = 2) or pulmonary (n = 4) hydatid cyst. The pulmonary cysts were diagnosed with radiography in 18 patients and thoracic computed tomography scan in 30. The pulmonary cysts of 9 patients were bilateral. Seventy-five pulmonary cysts were seen in radiological examinations. The diagnosis of hepatic cysts was established with ultrasonography in 18 patients and upper abdominal computed tomography in 30. The total number of hepatic cysts was 48. In cases with pulmonary cysts, cystotomy and capitonnage were performed in 32 patients, only cystotomy was done in 14 patients, and wedge resection was performed in 2. Liver cysts were approached to transdiaphragmatically after the lung cysts had been dealt with and were managed with evacuation of the cysts. In the remaining cases, marsupialization (n = 2), pericystectomy (n = 1), and enucleation (n = 1) were performed. Major postoperative complications were hemorrhage (n = 1) and biliocutaneous fistula (n = 1). Hepatic recurrence was seen in 3 patients (6.2%) and pulmonary recurrence in 1 (2.1%). CONCLUSION: Transthoracic approach is a useful and a safe surgical management of both pulmonary and upper surface of hepatic hydatid cysts.     

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.     

Diagnostic pitfalls of spinal echinococcosis

OBJECTIVE: To critically examine and elucidate the diagnostic pitfalls of spinal echinococcosis. SUMMARY OF PATIENTS: From October 1957 to June 2006, 25 consecutive cases drawn from 5721 cases of echinococcosis were collected in the First Affiliated Hospital of Xinjiang Medical University. The selected cases comprised 11 males and 14 females; all were treated with debridement operations. The average age was 28.3 years (15 to 56 y). The average duration of infestation with spinal hydatid disease was 3.2 years (0.5 to 12 y). Nineteen of the 25 cases underwent magnetic resonance imaging (MRI) scanning, which identified 17 out of 19 cases as having hydatid disease. The lesion was located in the cervical vertebrae in 3, the thoracic vertebrae in 11, the lumbar vertebrae in 5, and the sacrum in 6 cases. RESULTS: Eighteen cases were available for follow up; the period ranging from 0.5 to 15 years with an average of 3.6 years. The Casoni test was performed in 15 cases and was positive in 12 patients (80%). In addition, 4 cases were positive in all of the so-called 8 tests of immunodiagnostic methods. MRI examination was performed in 19 of the 25 cases and 17 of these were diagnosed as having spinal hydatid disease (89.47%). The typical MRI appearance is that of a multilocular cyst and the signal of the parent cyst is similar to that of muscle and higher than that of secondary cyst in the T1Weighted image (WI). The signal of the secondary cyst is similar to water, either located in or overflowing or adjacent to the parent cyst. Both the parent and the secondary cysts showed high signals in the TW1 with either rose or wheel shapes. In the 18 cases, which were reviewed, 11 cases had relapsed (61.11%). CONCLUSIONS: Although x-ray or computed tomography images of spinal echinococcosis are similar to tuberculosis, metastases, giant cell tumors, or cysts of the bone, MRI shows distinctive diagnostic features of spinal hydatid disease. Serologic examinations are important to confirm the correct diagnosis.     

Risk for laparoscopic fenestration of liver cysts

Background: Laparoscopic fenestration is considered the best treatment for symptomatic simple liver cysts. Conversely, the laparoscopic approach for the management of hydatid simple liver cysts is not widely accepted because of the risk for severe complications. Despite improvement in imaging techniques, the probability of preoperatively mistaking a hydatid liver cyst for a simple liver cyst remains about 5%. Therefore, laparoscopic fenestration, planned for a liver cyst could be performed unintentionally for an undiagnosed hydatid liver cyst. Methods: From January 2000 to January 2001, 15 patients with a diagnosis of liver cyst underwent laparoscopy for fenestration. In all cases preoperative serologic and imaging assessment had excluded hydatid liver cyst. To further exclude hydatid liver cyst, preliminary aspiration of the cyst with assessment of cystic fluid characteristics was performed. Results: In two patients with presumedly simple liver cyst, hydatid liver cyst was diagnosed instead at laparoscopy by aspiration of cystic fluid. The procedure was converted to laparotomy with subtotal pericystectomy. Conclusions: The risk of misdiagnosing a hydatid liver cyst for a simple liver cyst, especially in the presence of a solitary cyst, should be considered before laparoscopic fenestration is performed. Intraoperative aspiration of cyst fluid before fenestration can minimize this risk, thus avoiding severe intraoperative and late complications.     

肝包虫囊肿外囊完整剥除术的探讨(附58例报告)

目的:探讨外囊完整剥除术治疗肝包虫病的手术方式、适应证及疗效评价。方法:对58例肝包虫病患者利用在包虫囊肿外囊壁与正常肝组织之间的间隙剥离,将包虫囊肿完整剥除,总结手术技巧,观察疗效,探讨手术适应证。结果:全组58例共完整剥除65个包虫囊肿,患者均治愈,无死亡。术中大出血(出血量>1 500 mL)6例,经输血等治疗痊愈;术中出现过敏反应1例,经及时抗过敏治疗,术后痊愈;术后胆汁漏8例,经腹腔引流管充分引流至无,复查腹腔B超无积液,拔出引流管痊愈;2例Ⅶ、Ⅷ段包虫囊肿剥离术后右侧胸腔少量积液,经对症抗感染支持治疗,7～14 d后复查胸片,胸水吸收痊愈。结论:外囊完整剥除术治疗肝包虫病具有并发症少、根治病变的效果。随着施术者经验技术的提高,掌握适应证,出血、胆汁漏等并发症可以降到最低,值得临床进一步推广。     

Complications after removal of hepatic echinococcal cysts and possibilities of their prevention]

Operative treatment of hydatid disease is the only radical method at present. According to the data in the literature, the incidence of postoperative complications in patients with hydatid disease of the liver ranges from 14.32 to 64%. The work generalizes the results of operations in 278 patients with hepatic hydatid disease. Closed echinococcectomy was conducted in 168 (65.87%) patients, partly closed--in 34 (12.23%), open echinococcectomy--in 14 (5.04%), pericystectomy--in 21 (7.55%), ideal echinococcectomy--in 17 (6.12%), resection of the liver with removal of the hydatic cyst--in 15 (5.4%), and percutaneous transhepatic drainage of the cyst--in 9 (3.2%) patients. Postoperative complications occurred in 32 (11.51%) cases. Among them were suppuration of the residual cavity in 19, external biliary fistula in 11, and subdiaphragmatic abscess in 2 patients. The least number of complications was encountered after closed echinococcectomy--in 5 (2.97%) patients. One patient died after partly closed echinococcectomy as the result of development of multiple cholangiogenous hepatic abscesses. The results of the authors' observations provide evidence that the character and frequency of postoperative complications are determined by timely diagnosis of echinococcosis of the liver before the development of complicated forms, correct choice of the type of the operation, and the techniques of the operation and the operative approach.     

Laparoscopic pericystectomy for liver hydatid cysts

Background: The laparoscopic approach for managing of liver echinococcosis is a controversial issue because of scarce experience worldwide. The aim of this report is to describe the technical details of our laparoscopic method and present our results. Methods: Consecutive cases of liver echinococcosis managed by laparoscopic surgery are reported. Thoracic x-ray and abdominal ultrasound had been performed previously. The following aspects were considered as selection criteria: unique cyst located in segments III, IV, V, VI, and VIII; diameter less than 7 cm; and no evidence of infection or calcification. An evacuating puncture was performed, germinative membrane removed, and pericystectomy performed, which extirpated the pericystic structure with the surrounding liver parenchyma. Specimens were removed in a plastic bag through one of the ports. Surgical morbidity, hospital stay, time until return to work, and evidences of hydatid recurrence were measured. Results: Surgery was performed on eight patients (5 women and 3 men) with a mean age of 44.9 years (range, 22–83 years) who had a liver hydatid cyst with a mean diameter of 6.6 cm (range, 5–7 cm). During a mean follow-up period of 30 months (range, 23–44 months), no morbidity or hydatid recurrence were verified. Hospital stay was 2 days in all cases, and return to work was within 15 days. Conclusion: This laparoscopic technique, applied with selective criteria, can be a useful alternative for treating patients with liver hydatidosis because its results are comparable with those for open surgery studies involving similar follow-up time.     

评估X、CT及MRI在脊柱包虫病诊断中的价值

目的 回顾性分析25例脊柱包虫病的临床表现和影像特点,探讨其诊断及误诊原因.方法 1957年10月至2006年6月收治5721例包虫病中,脊柱包虫病患者25例,男14例,女11例,年龄15-56 岁,平均28.3岁,病史0.5-12 年,平均3.2年.发病部位:颈椎3例,胸椎11例,腰椎5例,骶骨6例.从临床、流行病学、影象学及免疫学等方面综合分析,总结其影像学特点及误诊原因.结果 25例脊柱包虫中有23例来自农牧区或有犬羊密切接触史(92%).25例均行X线检查,13例行CT检查,5例(38.46%)诊断包虫.19例行MR检查,17例(89.47%)诊断为包虫病,多房性是本病的特征之一,T1WI母囊信号高于子囊是其另一特征.15例行皮内casoni试验,阳性12例(80%),4例行包虫病八项免疫试验均为阳性.结论 脊柱包虫病X线和CT表现易误诊为结核、转移瘤、骨巨细胞瘤或骨囊肿等,MRI有助于脊柱包虫的诊断与鉴别诊断,血清学检查对确诊诊断有很大帮助.     

Surgical treatment of hydatid cysts of the lung: report on 1055 patients.

Of 1055 patients treated surgically for pulmonary hydatid disease, most (950) had isolated lung cysts, the other 105 having both liver and lung cysts. The chest radiograph was most valuable in diagnosis; the Casoni and Weinberg tests and blood eosinophil counts were found to be diagnostically unreliable. One thousand and seventy seven primary operations were performed. Cystotomy and capitonnage were carried out in 906 patients, 40 of whom also had decortication of the pleura. Other procedures included cystotomy with wedge resection of locally damaged lung (29 patients) and cyst removal with capitonnage by Ugon's method (33) or the Perez-Fontana procedure (8) and with costal resection for osteomyelitis in two cases. More radical surgery was carried out in 99 patients for longstanding infection or severe lung destruction. Postoperative complications occurred in 37 patients (3.5%) and the 30 day mortality rate was 1.7%. It is concluded that a lung conserving surgical operation is the treatment of choice for most patients with pulmonary hydatid disease. In patients with coexisting liver cysts the thoracic transpleural approach allowed the lung and liver cysts to be removed at the same session.     

Diagnosis and management of hydatid liver disease in children: a report of 156 patients with hydatid disease

Background/PurposeThere are many published reviews on adult hydatid disease and a guideline published by World Health Organization Informal Working Group (WHO-IWGE) in 2010. However, there are very few reports on hydatid liver disease in children with limited numbers of patients, and no comments were offered on childhood hydatid liver disease in the WHO-IWGE 2010 guideline. The aim of this study is to present our 17-year experience with 156 pediatric patients with hydatid liver disease and provide a treatment algorithm for children.MethodsThe clinical records of 156 children with hydatid liver disease treated from January 1994 to January 2011 were retrospectively reviewed. Patient sex, age at diagnosis, symptoms, disease location, cyst numbers and sizes, treatment choices, medical treatment duration, surgical methods, and complications were recorded. Treatment of liver hydatidosis included 3 different schedules: (1) small (<5 cm) liver cysts treated with albendazole (ABZ) only, (2) cysts (>5 cm) located at the liver surface treated with surgery combined with ABZ, and (3) all (>5 cm) liver cysts embedded deep in the liver parenchyme treated with percutaneous drainage and ABZ. Albendazole was given (10 mg/kg twice a day) and continued for 6 months after initial therapy.ResultsThere were 92 boys and 64 girls with an average age of 9.2 years (range, 1.1-15 years). A total of 376 cysts were detected in 156 patients. The follow-up period ranged from 1 to 10 years (median, 6.5 years). Complications were classified according to the Dindo classification. After the first 6 months of therapy, grade I complications occurred in 12.1% of patients, grade II complications in 7.4%, and grade IIIb complications in 7.3%. There were no grade IIIa, IVa, or IVb complications. At 1 year, grade II complications were recorded in 9.6% of 15 patients, and grade IIIb complications, in 1.2% of patients. During the 17 years reviewed, there were no mortalities (0% grade V complications).ConclusionsBased on this experience, we believe that suitable treatment should be chosen based on factors such as cyst number, cyst location (on the surface or deep in the organ), proximity to vascular structures, whether the cyst is complicated, and additional organ involvement or not. In addition, although the results of our study mostly agree with the results in the WHO-IWGE 2010 report, there are some noticeable differences between these 2 studies. Hence, we believe that the WHO-IWGE 2010 recommendations should be updated by incorporating the childhood observations.     

Surgery for thoracic hydatid disease: a North American experience

The clinical course of 20 patients with 22 thoracic hydatid cysts operated on from 1957 to 1984, was reviewed. Follow-up extended to 27 years (mean, 11.6 +/- 1.5 years [+/- the standard error of the mean]) and was 90% complete. Most patients originated from countries in the Mediterranean region; 5 were native Canadians. The diagnosis was suspected in all but 3 patients preoperatively. Fourteen patients had 16 primary lung cysts, 4 had infected liver cysts with intrathoracic extension, 1 had synchronous unruptured liver and lung cysts, and 1 had a thymic cyst. Nine cysts were intact, whereas 13 had ruptured preoperatively. A variety of surgical procedures was performed, including eight wedge resections and nine lobectomies. There were no early deaths, and perioperative complications were infrequent. One patient with a hepatic cyst that had ruptured into the right pleural space and right lower lobe died at 7 months of massive echinococcosis of the liver and intraabdominal sepsis. There has been no evidence of thoracic recurrence in any of our long-term survivors, although 1 patient had undergone enucleation of a left lung cyst in Greece 15 years prior to her reoperation here for a lingular recurrence. We conclude that thoracic hydatid disease is a rare entity in northeastern North America. The prevalence of ruptured cysts and infected hepatic cysts involving the lung was higher than in most other series, thereby necessitating more aggressive surgical treatment. Nevertheless, morbidity was low, and recurrence of disease was uncommon in long-term follow-up.     

Surgical Treatment of Liver Echinococcosis — the Role of Laparoscopy

Background: The surgical approach to liver echinococcosis is still a controversial issue. This study shows our results of surgical treatment of liver hydatid cysts during a 5-year period.

Methods: A prospective study of 21 patients operated on in a 5-year period (1999–2003), in Dubrava University Hospital in Zagreb, Croatia, with hepatic hydatid cyst. All patients were pre-operatively treated with albendazole. In 12 patients, total pericystectomy without opening the cyst cavity was performed, 9 open and 3 laparoscopic. In the other 9 patients, partial pericystectomy was done, 6 open and 3 laparoscopic.

Results: There was no mortality after 5–65 months follow-up, but in 1 patient, in the open partial pericystectomy group, recurrence of the disease occurred after 3 years. When a laparoscopic procedure was done, there were no complications or recurrence. The median operative duration for open surgery was 100.0 min (range 60.0-210.0), and for laparoscopic surgery 67.5 min (range 60.0-120.0). The median length of hospitalisation for open surgery was 8.0 days (range 7.014.0), and for laparoscopic surgery 5.0 days (range 4.0-7.0).

Conclusion: Total pericystectomy without opening the cyst cavity, preceded by pre-operative albendazole therapy is the method of choice for hepatic hydatid cyst treatment. Despite the small group of patients, our first results show laparo-scopic total pericystectomy without opening the cyst cavity, in the treatment of hepatic hydatid cyst, as a good alternative to open surgery in selected patients.     

Bile leakage test in emergency hydatid liver cyst surgery

Introduction and importanceIn liver cyst hydatid surgery, presence of cysto-biliary communication (CBC) is important for the prevention of postoperative morbidity. If cysto-biliary connections are not obvious, diagnosis is not easy. Intraoperative bile leakage test has been shown to reduce postoperative biliary complications by revealing occult CBCs. However, bile leakage testing in emergency conditions such as hydatid cyst perforation has not been experienced so far.Case presentationHere, a bile leakage test performed in a 23-year-old male patient undergoing emergency surgery due to the perforation of the hydatid liver cyst was presented. Following the treatment of perforated hydatid liver cyst and biliary peritonitis, a bile leakage test was performed. The common bile duct was cannulated with a 22G catheter, normal saline and parenteral lipid solution were given to demonstrate the CBCs, and leakage areas were suture ligated. The patient was discharged postoperatively without any problem.ConclusionWe recommend detection and treatment of the CBCs even in emergency hydatid liver cyst surgery for prevention of postoperative biliary complications.     

Predictors of morbidity and mortality in the surgical management of hydatid cyst of the liver

Background/aims Surgery for hydatid cyst of the liver is widely practiced worldwide; this type of management is still associated with high mortality and morbidity. The aim of this study is to find out possible predictors for this high mortality and morbidity. Materials and methods The medical records of 169 patients who underwent surgery for hydatid cyst of the liver were retrospectively reviewed. The mortality and the morbidity rates were assessed as well as the following eight potential predictors of mortality and morbidity: age of the patients, size of the cyst, number of cysts, other organs involved by the disease, the presence of preoperative complications, the type of surgery performed (radical or conservative), whether the disease was new or recurrent, and when surgery was performed in the first period (1973–1986) or in the second period (1987–1999). Cross-tabulation and logistic regression between mortality and morbidity (dependent variable) and the above-mentioned eight potential predictors (independent variables) were carried out. Results Of the 169 patients, 112 were female subjects and 57 male subjects, the age range was from 5 to 85 years (mean=39.2 years), the mortality rate was 6.5% (n=11), and the overall morbidity rate was 53.8% (n=91), while specific complications of liver hydatid cyst surgery were seen in 32% (n=54). Patients of age >40 years, with a cyst diameter of >10 cm, who presented with pre-operative complications, who had conservative surgery, and who had surgery before 1987 were having a significantly higher mortality and morbidity rate. Conclusion Age, size of the cyst, the presence of pre-operative complications particularly cyst-biliary communication, and type of surgical procedure performed (conservative or radical) represent as significant predictors of mortality and morbidity of surgery for liver hydatid cyst.     

Cost-effective and time-saving surgical treatment of pulmonary hydatid cysts with multiple localization

Abstract. Purpose: The most frequent anatomic locations of hydatid cysts are the liver and lungs. Because there is no effective medical therapy against this parasitic disease, surgery is the treatment of choice. The aim of this retrospective study was to compare the cost and effect of a one-stage operation with those of two- or three-stage operations in the treatment of lung hydatid cysts with multiple localizations. Methods: We evaluated 364 patients who underwent surgical treatment for hydatid cysts, all of whom had multiple localizations. To avoid two- or three-staged operations, we performed median sternotomy, simultaneous bilateral thoracotomy and unilateral thoracotomy with a transdiaphragmatic approach. Results: For the treatment of 460 hydatid cyst localizations in 364 patients, a collective 381 operations were performed. The number of operations and periods of hospitalization were reduced. Conclusion: A one-stage surgical procedure for bilateral lung and liver hydatid cysts is superior to the traditional two- and three-stage operations because it reduces morbidity, hospital stay, and cost. Received: June 4, 2001 / Accepted: January 8, 2002     

Ultrasonic examination in diagnosis of hydatid echinococcosis

Out of 247 patients operated for suspected echinococcosis of the liver, 21 (8.5%) cases of non-parasitic diseases of the liver and other organs were revealed: non-parasitic cysts (7), hemangioma (4), abscesses (4), malignant tumors (3), hydronephrosis of the right kidney (2), polycystosis of the liver and right kidney (1). Analysis of echotomographic picture of cystic structures showed that combinations of symptoms did not correspond to echinococcus cyst. Interpretation of echotomographic symptoms in diagnosis of hydatid echinococcosis may lead to diagnostic mistake if location, size, form of cyst, pattern of complications and phase of vital activity of parasite were not taken into account. Results of ultrasound investigation (USI) is more important than data of serologic studies. It is necessary to perform poly-positioned USI for prevention of diagnostic mistakes.     

Echinococcosis of the diaphragm

According to the authors, echinococcosis of the diaphragm accounts for 2.24% of all hydatid lesions of the thoracic and abdominal organs. It is pointed out that preoperative diagnosis of concurrent and secondary echinococcosis of the diaphragm is difficult despite the performance of pneumoperitoneum and scanning of the liver. Ten of 12 patients were operated on for echinococcosis of the liver or right lung. One-staged closed echinococcectomy with removal of the residual cavity is the operation of choice in a single echinococcosis of the diaphragm or uncomplicated concurrent echinococcosis. Excision of the dome together with the cyst is recommended for suppurative echinococcosis and irreversible changes of the diaphragm.