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.     

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.     

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.     

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.     

Giant hydatid cysts of lung and liver

A 13-year-old girl was admitted to our clinic with the complaints of dyspnea, abdominal distention, cough, and right-sided chest pain.The diagnosis of disease was made with physical examination and radiologic evaluation. She underwent right thoracotomy and phrenotomy for the management of the hydatid cysts of the lung and the liver. The postoperative course was uneventful and she was discharged on the 10th postoperative day. We believe that the simultaneous management of concomitant pulmonary and hepatic hydatid cysts through a thoracicroute is a convenient option.     

Laparoscopic drainage of infected hydatid liver cysts

From October 1997 until March 1999, we performed this procedure in three patients suffering from suppurated echinococcal liver cyst. Trocar sites are approximately the same to those already known for laparoscopic cholecystectomy. A thoracostomy tube is inserted through the abdominal wall and under direct vision is forced to the projecting part of the cyst for the aspiration of the gross content. The adventitia and thinned out liver are cut with electrocautery and scissors. A large bore fenestrated drainage tube is inserted within the cavity of the cyst and fixed in place. We did not have wound infection in any of the three patients. The average hospital stay was 19 days. No signs of recurrence or any other source of morbidity were apparent within the 18, 14 and 6 months of follow up of the three patients respectively.     

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

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.     

Intrabiliary rupture of hydatid cysts of the liver

Background

Intrabiliary rupture is a common and serious complication of hepatic hydatidosis, and its treatment remains controversial.

Methods

Sixty-seven patients who underwent surgery for rupture of a hydatid cyst in the biliary tree were studied retrospectively. The following data were analyzed: age, sex, clinical presentation, and so on.

Results

In 55 patients, intrabiliary rupture was diagnosed preoperatively and in 12 patients intraoperatively. In 51 patients, partial pericystectomy and closed-tube drainage followed. Pericystorraphy was performed in 9 patients. Omentoplasty was performed in 5 cases. After the meticulous cleansing of the common bile duct, T-tube drainage (60 patients), choledochoduodenostomy (4 patients), or sphincteroplasty (1 patient) was added. In 4 patients, there was a persisting external biliary fistula. The mean length of hospital stay was 18 days. Follow up (1-35 years) elicited 4 recurrences and 1 postoperative death.

Conclusions

Our results in intrabiliary rupture of echinococcal cysts are considered to be satisfactory. Surgical treatment can be improved with the modern methods of investigation, wider use of newer chemotherapeutics, and appropriate modification of surgical procedures.     

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.     

Choledochoduodenostomy for intrabiliary rupture of hydatid cysts of liver

Frank intrabiliary rupture is an important complication of liver hydatid cysts and its incidence is between 5 and 25 per cent. The main principles of management are the surgical treatment of the cyst with removal of all cystic elements and drainage of the biliary tree. Accurate pre- and intra-operative diagnosis and permanent drainage of the biliary tree by a wide choledochoduodenostomy are important to reduce morbidity and mortality. In this report 28 cases of frank intrabiliary rupture of hydatid cysts treated by choledochoduodenostomy are presented.