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Habeeb TAAM, Podda M, Tadic B, Shelat VG, Tokat Y, Abo Alsaad MI, Kalmoush AE, Nassar MS, Mustafa FM, Morsi Badawy MH, Sobhy Shaaban M, Mohamed TZ, El Sayed Henish MI, Elbelkasi H, Abdou Yassin M, Mostafa A, Ibrahim A, A-Abdelhady W, Elshahidy TM, Mansour MI, Moursi AM, Abdallah Zaitoun M, Abd-Allah ES, Abdelmonem Elsayed A, S Elsayed R, M Yehia A, Abdelghani A, Negm M, Abo-Alella HA, Elaidy MM. Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study. World J Methodol 2023; 13:272-286. [PMID: 37771864 PMCID: PMC10523247 DOI: 10.5662/wjm.v13.i4.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Hydatid cyst disease (HCD) is common in certain locations. Surgery is associated with postoperative biliary fistula (POBF) and recurrence. The primary aim of this study was to identify whether occult cysto-biliary communication (CBC) can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase (ALP) levels in predicting POBF and recurrent HCD. AIM To identify whether occult CBC can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD. METHODS From September 2010 to September 2016, a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty. Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence. RESULTS There was a highly statistically significant association (P ≤ 0.001) between cystic fluid biochemical indices and the development of biliary complications (of 16 patients with POBF, 15 patients had high cyst fluid bilirubin and ALP levels), where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association (P ≤ 0.001) between biliary complications, biochemical indices, and the occurrence of recurrent HCD (of 30 patients with recurrent HCD, 15 patients had high cyst fluid bilirubin and ALP; all 16 patients who had POBF later developed recurrent HCD), where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts, respectively. CONCLUSION Occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.
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Affiliation(s)
- Tamer A A M Habeeb
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari 09126, Italy
| | - Boris Tadic
- Clinic for Digestive Surgery – First Surgical Clinic, University Clinical Centre of Serbia, Belgrade 11000, Serbia
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 018971, Singapore
| | - Yaman Tokat
- Department of Liver Transplantation and Hepatobiliary Surgery, Istanbul, Turkey, International Liver Center, and Acibadem Hospital Group, Istanbul 34000, Turkey
| | | | - Abd-Elfattah Kalmoush
- Department of General Surgery, Faculty of Medicine, Al-Azher University, Cairo 11765, Egypt
| | | | - Fawzy Metwally Mustafa
- Department of General Surgery, Faculty of Medicine, Al-Azher University, Cairo 11765, Egypt
| | | | - Mohamed Sobhy Shaaban
- Department of General Surgery, Faculty of Medicine, Al-Azher University, Cairo 11765, Egypt
| | - Tarek Zaghloul Mohamed
- Department of General Surgery, Faculty of Medicine, Al-Azher University, Cairo 11765, Egypt
| | | | - Hamdi Elbelkasi
- Department of General Surgery, Mataryia Teaching Hospital, Cairo 11765, Egypt
| | - Mahmoud Abdou Yassin
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Abdelshafy Mostafa
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Amr Ibrahim
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Waleed A-Abdelhady
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | | | | | - Adel Mahmoud Moursi
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | | | - Ehab Shehata Abd-Allah
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | | | - Rasha S Elsayed
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Ahmed M Yehia
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Amr Abdelghani
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Mohamed Negm
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | | | - Mostafa M Elaidy
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
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Masood PF, Mufti GN, Wani SA, Sheikh K, Baba AA, Bhat NA, Hamid R. Comparison of laparoscopic and open surgery in hepatic hydatid disease in children: Feasibility, efficacy and safety. J Minim Access Surg 2022; 18:360-365. [PMID: 35708380 PMCID: PMC9306114 DOI: 10.4103/jmas.jmas_220_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Surgery continues to be the mainstay of treatment of hydatid cysts of the liver. Laparoscopy provides a lesser invasive tool for achieving results same as with the established open surgical techniques. The purpose of the study was to evaluate the feasibility and safety of laparoscopic management of hepatic hydatid disease in children. Patients and Methods: It was a prospective randomised study conducted over a period of 7 years. Children with Gharbi Type I, II, III cysts, ≤3 cysts and superficial accessible cysts were treated laparoscopically and their outcomes were compared with matched controls treated by open approach. Results: Sixty patients were included in the study with thirty patients in each matched group. Thirty paediatric patients (male 12:female 18) with 35 liver hydatid cysts underwent laparoscopic surgery. The mean cyst size was 8.8 ± 2.39 cm. Two patients needed conversion to open. No significant spillage of cyst contents was observed in any of the patients. Duration of hospital stay, time to removal of drains, duration of parenteral analgesia, severity of pain in postoperative period, time to ambulation and time to return to full orals were significantly lower in laparoscopic group compared to open group. Complication rates in both the groups were similar. Conclusion: With proper patient selection, laparoscopic management of hydatid cysts of the liver in children is feasible and safe option with low morbidity, low rates of conversion and minimal complications.
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Affiliation(s)
| | - Gowhar Nazir Mufti
- Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Sajad Ahmad Wani
- Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Khurshid Sheikh
- Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Aejaz Ahsan Baba
- Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Nisar Ahamd Bhat
- Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Raashid Hamid
- Department of Paediatric Surgery, GMC, Srinagar, Jammu and Kashmir, India
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Laparoscopic Retrieval of Abdominal Cysts in Sheep and Goat. MACEDONIAN VETERINARY REVIEW 2021. [DOI: 10.2478/macvetrev-2021-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The study was planned to evaluate the use of laparoscopy for the diagnosis and retrieval of abdominal cysts in sheep and goats. The abdominal cysts were located in 10 of 135 adult, healthy small ruminants by using ultrasonography (USG). Percutaneous Puncture-Aspiration-Injection-Reaspiration (PAIR) technique was used for six animals. Thirty animals, including four diagnosed with abdominal cysts by USG, were subsequently subjected to laparoscopy under diazepam sedation (0.1 mg/kg, IV) and lumbosacral epidural regional anesthesia using 2% lignocaine hydrochloride (1.0 ml/5 kg). The animals were restrained in dorsal recumbency and two-port paramedian laparoscopy was performed. Abdominal cysts were located in seven animals (one cyst/animal). The cysts were grasped carefully, lifted close to the abdominal wall, and evacuated percutaneously under laparoscopic vision. The collapsed cysts were then retrieved. In two animals enlarged ports were sutured, treated with an antibiotic and an analgesic, resulting in uneventful healing. Five cysts were nonparasitic, two were parasitic, one extracted from a sheep, and one from a goat. In conclusion, laparoscopy has higher diagnostic accuracy in detecting unattached abdominal cysts in sheep and goats compared to USG. It is also a reliable, minimally invasive, and safe procedure for cyst retrieval. However, a larger-scale study is necessary for ascertaining long-term complications and the recurrence rate.
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Evaluation and Comparison of the Early Outcomes of Open and Laparoscopic Surgery of Liver Hydatid Cyst. Surg Laparosc Endosc Percutan Tech 2016; 25:403-7. [PMID: 26429050 DOI: 10.1097/sle.0000000000000199] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Surgery is the mainstay for treatment of liver hydatid cyst. Different surgical procedures have been suggested, but it is important to select the most appropriate treatment to obtain the best results with the lowest rate of recurrence and minimal morbidity and mortality. The aim of this study was to evaluate the early outcomes of open and laparoscopic surgery of hydatidosis. MATERIALS AND METHODS In this study, 75 patients with uncomplicated liver hydatid cyst were assigned prospectively to either groups of laparoscopic surgery (37, 50.68%) or open procedure (36, 49.32%) during the period of 2007 to 2012. Conversion to open surgery was required in 2 patients (2.67%), who were excluded from the study. Patients were followed for about 17.86±17.64 months. RESULTS Participants included 73 patients: 49 (67.12%) female and 24 (32.88%) male patients, with the mean age of 38.97±16.48 years. There was no statistically significant difference between the 2 groups with regard to the sex, the occupation, and the mean diameter of the cysts. Bilious staining of the cyst content was observed in 23 (35.94%) patients during surgery, and a maximum diameter of 91 mm was considered as a cut point for predicting postoperative fistula with 69.2% sensitivity and 41.1% specificity. The mean duration of operation, postoperative pain, the hospitalization time, and the time to return to work were significantly lower in the laparoscopic group. Postoperative biliary fistula, cyst cavity infection, and wound infection were not different between the 2 groups. CONCLUSIONS Laparoscopic surgery seems to be effective and safe, with low morbidity rates for uncomplicated cysts in accessible segments of the liver.
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The Comparison of 2 New Promising Weapons for the Treatment of Hydatid Cyst Disease: PAIR and Laparoscopic Therapy. Surg Laparosc Endosc Percutan Tech 2016; 25:358-62. [PMID: 26241297 DOI: 10.1097/sle.0000000000000177] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND To compare the effectiveness and safety for hydatid disease treatment, the 2 new minimally invasive therapies: laparoscopic and PAIR (puncture, aspiration, injection, and reaspiration) were compared by systematic meta-analysis. METHODS A comprehensive analysis of published cases from 1990 to 2014 was performed using PubMed database. A total of 231 publications on laparoscopic treatment of hydatid cysts and 298 publications on the PAIR treatment were identified. Thirty-eight studies involved 1230 laparoscope-treated subjects and 41 involved 2686 PAIR-treated subjects in this review. The effectiveness and safety of emphasis is placed on the recurrence, insufficient response, death, cure, and postoperative complications. Operation time and hospital stay are also discussed as new evaluation index. The stages of cyst are summarized to determine which stage is suitable for PAIR. RESULTS Clinical and parasitological cure occurred in 98.7% of patients undergoing laparoscopic intervention and in 97.5% of patients receiving PAIR plus chemotherapy (P<0.014). Recurrence occurred in 1.0% and 1.6%, respectively (P<0.087). Insufficient response occurred in 0.16% and 0.9%, respectively (P<0.009); 2 patients died in each group (P<0.594). Allergic reaction/urticarial/anaphylactic shock occurs in 0.14% and 4.24% of patients receiving laparoscopic intervention and PAIR plus chemotherapy, respectively (P<0.001). Infection/abscess (5.37% and 2.57%; P<0.001) and surgical-related complications (7.32% and 3.43%; P<0.001) were seen more frequently in laparoscopic intervention subjects than PAIR plus chemotherapy subjects. CONCLUSIONS Laparoscopic therapy and PAIR intervention are shown to be safe and effective alternative for open surgery with suitable indication such as cyst type and location. They have different postoperative complication features. The biliary fistula/bile leakage was more frequent in laparoscopic intervention (P<0.001) and fever occurred more in PAIR plus chemotherapy patients.
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Stancu B, Andercou O, Pintea D, Mironiuc A, Pop DA. Laparoscopic simultaneous partial pericystectomy and total cystectomy for hydatid liver cysts - case report. Med Pharm Rep 2015; 88:415-9. [PMID: 26609279 PMCID: PMC4632905 DOI: 10.15386/cjmed-416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 03/24/2015] [Accepted: 03/29/2015] [Indexed: 01/22/2023] Open
Abstract
Surgery remains the gold standard for the treatment of patients with echinococcosis, despite significant economic costs, advances in medical treatment and interventional radiology; in the past decades there has been a tendency toward laparoscopic surgery. We present a 66-year-old patient, from a rural area, who was admitted to our service complaining of spontaneous and palpatory pains in the right hypocondrium, headaches and dizziness. Abdominal CT scan highlighted 2 round calcified tumors, one of 7.2 cm diameter (VIIIth segment) with liquid densities, and the other one localized higher, with a diameter of 2.3 cm (IVth segment). Under general anesthesia, after the neutralization of the content of the cyst with hypertonic saline irrigation, we performed laparoscopic partial pericystectomy of the VIIIth segment liver cyst and total laparoscopic cystectomy of the IVth segment liver cyst. Postoperative evolution was favorable without biliary fistula formation, postoperative infections or cystic cavities abscesses. Laparoscopic surgery seems to be effective and safe for uncomplicated cysts in accessible segments of the liver, combined with adjuvant albendazole therapy to reduce complications and postoperative morbidity, but the procedure has its own disadvantages such as a limited area of surgical manipulation.
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Affiliation(s)
- Bogdan Stancu
- 2nd Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Octavian Andercou
- 2nd Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Pintea
- 2nd Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Aurel Mironiuc
- 2nd Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan Alin Pop
- Department of Clinical Urology and Institute for Renal Transplantation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Bajwa SJS, Panda A, Bajwa SK, Kaur J, Singh A. Anesthetic challenges in the simultaneous management of pulmonary and hepatic hydatid cyst. Anesth Essays Res 2015; 5:105-8. [PMID: 25885312 PMCID: PMC4173378 DOI: 10.4103/0259-1162.84189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Hydatidosis is a parasitic infection caused by the encysted larvae of Echinococcus granulosus, commonly called as hydatid cyst. Almost all organs can be involved, but most commonly it affects liver (55%-70%) followed by the lungs (18%-35%). The surgery and anesthetic management become very challenging if these cysts are in or near the vicinity of vital organs, such as heart. Pulmonary hydatid cysts may rupture into the bronchial tree or pleural cavity and produce cough, chest pain, or hemoptysis and there are chances of injury to heart if the cyst is in close proximity to it. We are describing the successful management of such a case of pulmonary and hepatic hydatid cyst in a young female patient.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
| | - Aparajita Panda
- Department of Anesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
| | - Sukhwinder Kaur Bajwa
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
| | - Jasbir Kaur
- Department of Anesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
| | - Amarjit Singh
- Department of Anesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
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Gomez i Gavara C, López-Andújar R, Belda Ibáñez T, Ramia Ángel JM, Moya Herraiz &A, Orbis Castellanos F, Pareja Ibars E, San Juan Rodríguez F. Review of the treatment of liver hydatid cysts. World J Gastroenterol 2015; 21:124-131. [PMID: 25574085 PMCID: PMC4284328 DOI: 10.3748/wjg.v21.i1.124] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 09/16/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023] Open
Abstract
A review was carried out in Medline, LILACS and the Cochrane Library. Our database search strategy included the following terms: “hydatid cyst”, “liver”, “management”, “meta-analysis” and “randomized controlled trial”. No language limits were used in the literature search. The latest electronic search date was the 7th of January 2014. Inclusion and exclusion criteria: all relevant studies on the assessment of therapeutic methods for hydatid cysts of the liver were considered for analysis. Information from editorials, letters to publishers, low quality review articles and studies done on animals were excluded from analysis. Additionally, well-structured abstracts from relevant articles were selected and accepted for analysis. Standardized forms were designed for data extraction; two investigators entered the data on patient demographics, methodology, recurrence of HC, mean cyst size and number of cysts per group. Four hundred and fourteen articles were identified using the previously described search strategy. After applying the inclusion and exclusion criteria detailed above, 57 articles were selected for final analysis: one meta-analysis, 9 randomized clinical trials, 5 non-randomized comparative prospective studies, 7 non-comparative prospective studies, and 34 retrospective studies (12 comparative and 22 non-comparative). Our results indicate that antihelminthic treatment alone is not the ideal treatment for liver hydatid cysts. More studies in the literature support the effectiveness of radical treatment compared with conservative treatment. Conservative surgery with omentoplasty is effective in preventing postoperative complications. A laparoscopic approach is safe in some situations. Percutaneous drainage with albendazole therapy is a safe and effective alternative treatment for hydatid cysts of the liver. Radical surgery with pre- and post-operative administration of albendazole is the best treatment option for liver hydatid cysts due to low recurrence and complication rates.
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Abstract
Background: One of the most common problems faced in laparoscopic treatment of hydatid cysts is the difficulty in evacuating the particulate contents (daughter cysts and laminated membrane). Although various instruments and laparoscopic techniques have been described to evacuate the contents of hydatid cysts, most are not available at many surgical centers. Methods: By assembling disposable, cheap, and available anesthesia equipment with common laparoscopic instruments, a laparoscopic system was made to evacuate the contents of a hydatid cyst. Ten patients with hepatic hydatid disease underwent laparoscopic surgery using this new hydatid system between June 2011 and January 2013. Results: The procedure was completely straightforward. Twelve hydatid cysts (2 patients had 2 separated cysts) were evacuated without any spillage. All patients were followed for at least 8 months, with no evidence of recurrence. Conclusions: This simple apparatus, which can be assembled anywhere, was safely used to evacuate the contents of hydatid cysts without causing any spillage.
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The role of perioperative endoscopic retrograde cholangiopancreatography and biliary drainage in large liver hydatid cysts. ScientificWorldJournal 2014; 2014:301891. [PMID: 25431783 PMCID: PMC4241747 DOI: 10.1155/2014/301891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 12/29/2022] Open
Abstract
Background. The best surgical technique for large liver hydatid cysts (LHCs) has not yet been agreed on. Objectives. The objective of this study was to examine the role of perioperative endoscopic retrograde cholangiopancreatography (ERCP) and biliary drainage in patients with large LHCs. Methods. A 20-year retrospective study of patients with LHCs treated surgically at the University Clinical Center of Kosovo (UCCK). We divided patients into 2 groups based on treatment period: 1981–1990 (Group I) and 2001–2010 (Group II). Demographic characteristics (sex, age), the surgical procedure performed, complications rate, and outcomes were compared. Results. Of the 340 patients in our study, 218 (64.1%) were female with median age of 37 years (range, 17 to 81 years). 71% of patients underwent endocystectomy with partial pericystectomy and omentoplication, 8% total pericystectomy, 18% endocystectomy with capitonnage, and 3% external drainage. In Group I, 10 patients underwent bile duct exploration and T-tube placement; in Group II, 39 patients underwent bile duct exploration and T-tube placement. In addition, 9 patients in Group II underwent perioperative ERCP with papillotomy. The complication rate was 14.32% versus 6.37%, respectively (P = 0.001). Conclusion. Perioperative ERCP and biliary drainage significantly decreased the complication rate and improved outcomes in patients with large LHCs.
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Predictive factors of recurrence after surgical treatment for liver hydatid cyst. Surg Endosc 2014; 29:86-93. [PMID: 24962861 DOI: 10.1007/s00464-014-3637-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 05/16/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hydatid recurrence after surgery is about 10 %. It still constitutes a problem both in terms of pathophysiology and management of recurrence. AIM The aim of this study was to assess the management of abdominal hydatid recurrence after surgical treatment for liver hydatid cyst and to identify the predictive factors of recurrence. METHODS We retrospectively included all the patients operated on between January 1, 2008, and December 31, 2012, in the Department "B" of Charles Nicolle Hospital (Tunisia), for abdominal hydatid recurrence. Sixteen men and 33 women, with a median age of 45 years, were included. For all patients, clinical variables and morphological and intra-operative characteristics concerning both the hydatid cysts previously treated and the recurrent cysts were collected. Surgical procedures were recorded as well as the immediate and long-term outcomes. Comparative studies were performed: "extrahepatic recurrence versus No," "peritoneal recurrence versus No," and "open approach versus laparoscopic approach." A univariate analysis followed by a multivariate analysis was carried out to determine predictive factors of hydatid recurrence. RESULTS Comparative analysis showed that laparoscopic approach, segments II and III localization, and postoperative complications during the first intervention were associated with a greater number of both peritoneal and extrahepatic hydatid recurrence. Multivariate analysis retained the laparoscopic approach as a predictive factor of both peritoneal recurrence (OR 5.5; 95 % CI 1.56; p = 0.008) and abdominal extrahepatic recurrence (OR 3.54; 95 % CI 1.08; p = 0.035). CONCLUSION Laparoscopic approach for the treatment of liver hydatid cysts was associated with a higher rate of extrahepatic and peritoneal recurrence than open.
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Tuxun T, Aji T, Tai QW, Zhang JH, Zhao JM, Cao J, Li T, Shao YM, Abudurexiti M, Ma HZ, Wen H. Conventional versus laparoscopic surgery for hepatic hydatidosis: a 6-year single-center experience. J Gastrointest Surg 2014; 18:1155-60. [PMID: 24733256 DOI: 10.1007/s11605-014-2494-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 03/03/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study is to evaluate the clinical results of laparoscopic surgery compared with conventional surgery. METHODS Records of patients who underwent surgery for liver hydatid disease between 2005 and 2011 were reviewed. Operative time, blood loss, conversion to open, postoperative morbidity, mortality, hospital stay, and recurrence rate were measured. RESULTS Among 353 eligible patients, 60 were considered for laparoscopic and 293 for conventional surgery. Operative time was slightly increased in laparoscopic group. No major blood loss and blood transfusion were needed. Postoperative hospital stay was significantly short in laparoscopic group (3.8 ± 1.2 days) than that in conventional group (7.4 ± 1.4 days). The overall morbidity was 13.3 % (8/60) in laparoscopic and 19.8 % (58/293) in conventional group without significance. Both conversion rate and mortality was 0 %. One recurrence in laparoscopic (1.7 %, 1/60) and five in conventional group (1.7 %, 5/293) occurred within 48 months of follow-up. CONCLUSIONS Laparoscopic treatment of liver hydatid disease is safe and effective in selected patients with all its advantages.
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Affiliation(s)
- Tuerhongjiang Tuxun
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Centre, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Xinshi District, Urumqi, 830054, Xinjiang Uyghur Autonomous Region, China
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Tuxun T, Zhang JH, Zhao JM, Tai QW, Abudurexti M, Ma HZ, Wen H. World review of laparoscopic treatment of liver cystic echinococcosis--914 patients. Int J Infect Dis 2014; 24:43-50. [PMID: 24747089 DOI: 10.1016/j.ijid.2014.01.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/26/2013] [Accepted: 01/12/2014] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to provide a review of the world literature on the laparoscopic treatment of liver hydatid cyst. METHODS We conducted a literature search using PubMed, screening all English language publications on the laparoscopic treatment of liver hydatid cysts. Operative characteristics, perioperative morbidity, and clinical outcomes were tabulated. RESULTS A total of 57 published articles including 914 patients with 1116 hydatid cysts were identified. Of the resections done in the 914 patients, 89.17% were performed totally laparoscopically and 5.58% were gasless. The most common procedure was cystectomy (60.39%), followed by partial pericystectomy (14.77%) and pericystectomy (8.21%); the rest were segmentectomies. Conversion to open laparotomy occurred in 4.92% of reported cases (45/914). The common cause of conversion was anatomical limitations/inaccessible locations (16/45). The overall mortality was 0.22% (2/914 patients) and morbidity was 15.07%, with no intraoperative deaths reported. The most common complication was bile leakage (57/914). The postoperative recurrence was 1.09% (10/914 patients). CONCLUSIONS The laparoscopic approach is safe with acceptable mortality and morbidity for both conservative and radical resections in selected patients. Clinical outcomes are comparable to open surgery, albeit in a selected group of patients.
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Affiliation(s)
- Tuerhongjiang Tuxun
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Jin-Hui Zhang
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Jin-Ming Zhao
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Qin-Wen Tai
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Mierxiati Abudurexti
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Hai-Zhang Ma
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Hao Wen
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China.
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Samala DS, Gedam MC, Gajbhiye R. Laparoscopic Management of Hydatid Cyst of Liver with Palanivelu Hydatid System over a Period of 3 Years: A Case Series of 32 Patients. Indian J Surg 2014; 77:918-22. [PMID: 27011483 DOI: 10.1007/s12262-014-1064-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/27/2014] [Indexed: 12/28/2022] Open
Abstract
The aim of this article is to evaluate the role and safety of laparoscopic management of hydatid disease of liver using Palanivelu hydatid system (PHS)(1) with initial results. A prospective study of hepatic hydatid cyst underwent laparoscopic management using PHS, during the period from June 2008 to October 2010, in department of general surgery in a tertiary care institute. Selective patients were included in our study. Preoperatively 2 weeks and post operatively 6 weeks of Albendazole were given. All patients underwent surgery under general anesthesia. Hydatid cyst evacuation and omentoplasty were done with PHS system to prevent spillage. Cyst was irrigated with 2 % savlon. Drainage tube was kept near the cyst. There were 32 patients with 35 liver hydatid cysts operated. The mean operative time was 93.78 (70-180) min. Intraoperative complications were noted in two patients (6.2 %). Conversion was required in one patient (3.1 %). The mean duration of hospital stay was 3-10 days with an average of 5 days. There was no recurrence in mean follow-up of 3 years. There was no mortality with good subjective and objective cosmetic results. The laparoscopic cyst evacuation and omentoplasty using PHS are feasible and safe for treating the hydatid cyst of liver in selected patients. It aids early recovery with good cosmetic results.
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Affiliation(s)
- Devdas S Samala
- Seth G.S. Medical College and King Edward Memorial Hospital, Parel, Mumbai 400012 India
| | - Manik C Gedam
- Indira Gandhi Government Medical College and Hospital, Nagpur, India
| | - Raj Gajbhiye
- Indira Gandhi Government Medical College and Hospital, Nagpur, India
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The role of laparoscopy in the management of liver hydatid cyst: a single-center experience and world review of the literature. Surg Laparosc Endosc Percutan Tech 2013; 23:171-5. [PMID: 23579513 DOI: 10.1097/sle.0b013e31828a0b78] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Surgery is still the main modality in the treatment of hepatic hydatid disease. Laparoscopic methods, with their low morbidity, have gained prominence in many fields and, in some cases, have nearly replaced open surgery. In this report, a laparoscopic method for the treatment of hepatic hydatid disease is described, and the results in the 46 cases are presented and the published articles were reviewed. The method involves laparoscopic cystectomy, pericystectomy, and liver resection for hydatid disease. The postoperative courses of the patients were very comfortable and no complication related to the laparoscopic technique occurred. The postoperative parameters and the early follow-up results (average, 18 mo) are very encouraging. Laparoscopic treatment of liver hydatid disease is safe and effective in selected patients and offers all the advantages of a laparoscopic surgery. In experienced hands, laparoscopic pericystectomy have lower morbidity and recurrence rate compared with cystectomy.
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Laparoscopic approach to liver hydatidosis: initial experience. Cir Esp 2013; 93:248-51. [PMID: 24199733 DOI: 10.1016/j.ciresp.2013.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/21/2013] [Accepted: 06/09/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Hepatic hydatidosis is a pathology that has a worldwide distribution, and is frequent in some rural areas in Argentina. Surgical treatment still offers the best results. The laparoscopic approach is controversial because of lack of experience with this technique. OBJECTIVE To evaluate the feasibility and efficacy of the laparoscopic approach in this pathology and to present the experience obtained in a medical center in Argentina. MATERIAL AND METHODS We prospectively evaluated patients with a diagnosis of non complicatedhydatidosis, over 15 years of age whose cyst had the following characteristics: unique cyst, size less than 5 centimeters, located in the anterior segments or easy access. Analyzed data were: sex, age, cyst localization, treatment, operating time, morbidity and mortality and recurrence. RESULTS Nine patients were operated using a laparoscopic approach. The cysts were localized in the segments iii, iv, v and vi. Six patients were operated with pneumoperitoneum and 3 with a parietal traction device, in all the patients the first approach was a laparoscopic PAIR (punction, aspiration, injection and reaspiration). Seven Mabit-Lagrot procedures were performed and 2pericystectomies. The operative time was a mean of 89.7min and a hospital stay of 52h. The morbidity was 22.2% and the mortality was 0%.Mean follow-up of 19 months showed no recurrences. CONCLUSION A higher number of patients and a longer follow-up are necessary to evaluate the efficacy of approach; the laparoscopic approach seems to be safe. Our results coincide with the majority of other publications.
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Findikcioglu A, Karadayi S, Kilic D, Hatiopoglu A. Video-assisted thoracoscopic surgery to treat hydatid disease of the thorax in adults: is it feasible? J Laparoendosc Adv Surg Tech A 2013; 22:882-5. [PMID: 23137113 DOI: 10.1089/lap.2012.0272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Optimal treatment of intrathoracic hydatid diseases in adults involves complete removal of the cyst with parenchyma-preserving surgery. In current practice, thoracotomy remains the standard surgical approach for pulmonary hydatid cysts, so surgical experience is limited, particularly with regard to video-assisted thoracoscopic surgery (VATS). SUBJECTS AND METHODS Between June 2007 and May 2011, a selected series of 12 adult patients presenting with intrathoracic hydatid cysts underwent VATS. The cysts were completely removed using a three-trocar technique. RESULTS Complete removal of the cysts was successful in all patients. All cysts were diagnosed by computerized tomography, and 6 (50%) patients had a history of hydatid disease in the liver or lung. No serious postoperative complications were observed. Patients with thoracoscopic excision were discharged after a median of 2.9 days (range, 2-6 days). No recurrences or complications were observed during a mean follow-up of 29 months. CONCLUSIONS Considering the conversion and complication rates in our series, VATS should be the primary therapeutic choice for adults with thoracic hydatid cysts. Open surgical interventions in patients with large and uncomplicated cysts appear optional.
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Saylam B, Coşkun F, Demiriz B, Vural V, Comçali B, Tez M. A new and simple score for predicting cystobiliary fistula in patients with hepatic hydatid cysts. Surgery 2013; 153:699-704. [PMID: 23305599 DOI: 10.1016/j.surg.2012.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 11/16/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hepatic hydatid cysts are common disorders in Turkey. Although most patients are treated by percutaneous drainage, some cases require operative intervention. Biliary fistula is a major complication of hydatid cyst operations. The purpose of this study is to identify preoperative predictors of cystobiliary fistula (CBF) and to develop a scoring system for this disorder. METHODS Overall, 135 patients with hepatic hydatid cysts were included in this study. The following variables were analyzed as potential predictors of CBF: Age, gender, findings on physical examination, complete blood cell count, liver function tests, and ultrasonographic features of the cysts (type, diameter, number, and localization). RESULTS CBF was detected in 33 of 135 patients. Univariate analyses showed significant differences in cyst diameter, levels of alkaline phosphatase (ALP) and direct bilirubin, platelet count, and white blood cell (WBC) count between patients with and without CBF. On multivariate analyses, WBC count > 9,000/mm(3) (odds ratio [OR], 4.5), direct bilirubin level > 0.7 mg/dL (OR, 2.76), cyst diameter > 8.2 cm (OR, 5.48), and ALP level > 120 U/L (OR, 3.82) were significant and independent predictors of CBG. One point was given for the presence of each of these factors to develop a new score. The resulting area under the receiver operator characteristic curve was 0.803 (95% confidence interval, 0.726-0.866). CONCLUSION Preoperative detection and management of CBF are important issues in the treatment of hydatid cysts of the liver. Developing a scoring system based on routinely measured laboratory and radiologic factors will help the clinician to manage patients with hepatic hydatid cysts. External studies are needed to validate this new scoring system in routine clinical practice.
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Affiliation(s)
- Bariş Saylam
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Rasheed K, Zargar SA, Telwani AA. Hydatid cyst of spleen: a diagnostic challenge. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:10-20. [PMID: 23378949 PMCID: PMC3560132 DOI: 10.4103/1947-2714.106184] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Although splenic involvement alone in hydatid disease is very rare, spleen is the third most common organ involved in hydatid disease. The rarity of splenic hydatid disease poses a diagnostic challenge for clinicians, particularly in non-endemic areas. As the hydatid cyst can present as a simple cyst without having the classic serological and imaging features, and later can lead to life-threatening complications like anaphylaxis, hydatid disease of spleen should be considered in differential in every patient in endemic areas with cystic lesion of spleen until proved otherwise. The author used the keyword “splenic hydatid cyst” in PubMed and reviewed the scientific literatures published from January 1965 to June 2012. The present review is to accentuate the incidence, classification, clinical and pathophysiological features, differential diagnosis, diagnostic modalities, and treatment choices of hydatid cyst of spleen along with follow-up strategy and newer treatment approaches.
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Affiliation(s)
- Khalid Rasheed
- Department of Internal Medicine, University of Alabama at Birmingham, Health Center Montgomery, Alabama, USA
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Zaharie F, Bartos D, Mocan L, Zaharie R, Iancu C, Tomus C. Open or laparoscopic treatment for hydatid disease of the liver? A 10-year single-institution experience. Surg Endosc 2013; 27:2110-6. [PMID: 23370963 PMCID: PMC3661041 DOI: 10.1007/s00464-012-2719-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 11/13/2012] [Indexed: 01/22/2023]
Abstract
Background Selection of the most appropriate treatment to obtain the lowest morbidity, mortality, and recurrence rates is mandatory for hydatid disease of the liver. This study evaluated the results of laparoscopic treatment (compared with the open approach) in the context of a 10-year single-institution experience. Methods Between January 1998 and January 2008, 333 patients with hydatid disease of the liver underwent surgery in the authors’ department. Only the following aspects were considered as selection criteria for laparoscopic surgery: liver cyst not located in segment 1 or 7, with corticalization on the surface and no evidence of intrabiliary rupture. Of 62 patients who underwent laparoscopic treatment, 3 required conversion to open surgery. The remaining 59 patients (group 1) were analyzed. During the same period, 271 patients with hepatic hydatid disease underwent conventional surgery, but only 172 records were compatible with the criteria for the laparoscopic approach and the respective patients were retrospectively reviewed (group 2). Results Conversion to open surgery occurred in three cases (4.84 %). The mean cyst diameter was 6.62 cm (range, 2–15 cm) in group 1 and 7.23 cm (range, 2–18 cm) in group 2 (p = 0.699). The mean operative time was 72 min (range, 45–140 min) in group 1 and 65 min (range, 35–120 min) in group 2 (p < 0.001). The general complication rate and abdominal wound complication rate were respectively 0 % and 0 % in group 1 (p = 0.023) compared with 5.23 and 8.72 % in group 2 (p = 0.015). The mean hospital stay was 6.42 days (range, 1–21 days) in group 1 and 11.7 days (range, 4–80 days) in group 2 (p < 0.001). The mean follow-up period was 24.2 months (range, 6–32 months) in group 1 and 28.4 months (range, 6–40 months) in group 2. No recurrences were observed in either group during this period. Conclusion Laparoscopic surgery provides a safe and efficacious approach for almost all types of hepatic hydatid cysts. Large, prospective, randomized trials are needed to confirm its superiority.
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Affiliation(s)
- Florin Zaharie
- Department of Surgery, Iuliu Hatieganu, University of Medicine and Pharmacy, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 19-21 Croitorilor Street, 400162, Cluj-Napoca, Romania.
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"Primary omental hydatid cyst": a rare entity. Case Rep Surg 2012; 2012:654282. [PMID: 23050190 PMCID: PMC3461611 DOI: 10.1155/2012/654282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 08/30/2012] [Indexed: 11/18/2022] Open
Abstract
Hydatid cyst is caused by the parasite Echinococcus granulosus commonly seen in temperate regions. Primary omental hydatid cyst is rare entity. Diagnosis can be achieved with contrast-enhanced computed tomography of abdomen and pelvis along with serology. Eosinophilia is a strong pointer to hydatid cyst as a differential diagnosis. Open or laparoscopic excision of the cyst along with medical therapy remains the treatment of choice.
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Bedioui H, Ayari H, Bouslama K, Maghrebi H, Hsairi H, Jouini M, Kacem JM, Safta ZB. Les facteurs prédictifs de récidive du kyste hydatique du foie : l’expérience tunisienne. ACTA ACUST UNITED AC 2012; 105:265-9. [DOI: 10.1007/s13149-012-0243-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/27/2012] [Indexed: 01/20/2023]
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Abstract
BACKGROUND Hepatic hydatid disease is now rare in Australasia. However, it remains a significant problem in endemic areas. Many cases are now managed using minimally invasive techniques and this paper reviews the current status of laparoscopic approaches to hepatic hydatid disease. METHODS A Medline data search was performed using the search terms of Ecchinococcos, laparoscopy, hepatectomy and pericystectomy. All publications from all publication years, including foreign language publications, were included. RESULTS Eight series have been published comprising five or more patients, with most utilizing techniques of laparoscopic cystectomy. All series managed Gharbi cyst types I-IV, and median operative times were between 60 and 82 min. Seven conversions were reported (3%) for problems with access or bleeding. There was one reported fatality, and between 5% and 45% (median 13%) of patients developed complications. Three cases of anaphylaxis were reported and 14 cases of bile fistula were reported (median incidence: 6%). Hospital stays were between 3 and 10 days (median stay: 3.5 days). Two series report recurrences (recurrence rates of 3% and 4%) and these were in patients not treated with preoperative albendazole. CONCLUSION Laparoscopic surgical techniques have been successfully applied to the treatment of hepatic hydatid cysts. While the uptake of these procedures is limited to areas of high prevalence and units with a specific interest, laparoscopic surgery is now one of the management options available to treat hepatic hydatid disease.
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Affiliation(s)
- Jonathan B Koea
- Department of Surgery, North Shore Hospital, Takapuna, Auckland, New Zealand.
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SuryaPrakash V, Punit M, Ajit V, Sreedhar D, Chandra-Mohan G, Vedamurthy PR, Sushanth K. Combined laparoscopic and percutaneous management of calcified renal hydatid cyst--a novel nephroscope- and lithotripter-assisted technique. Urology 2012; 79:1407-9. [PMID: 22542422 DOI: 10.1016/j.urology.2012.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/02/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To describe the novel technique of percutaneous nephroscope-assisted renal hydatid cyst evacuation and lithotripter-assisted division of the cyst wall for combined laparoscopic and percutaneous management. METHODS A calcified hydatid cyst of the kidney is a rare entity and needs special techniques for total laparoscopic management. A 45-year-old woman was treated successfully for a calcified renal hydatid cyst using the transperitoneal laparoscopic technique. A chlorhexidine gluconate and cetrimide mixture was used as the scolicidal solution to sterilize the cyst. The endocyst and daughter cysts were removed completely under vision, after placement of a single 26F nephroscope through a 10-mm port in the cyst, with grasper and lithotripter suction, using chlorhexidine-cetrimide mixture irrigation. Laparoscopic suction did not work well for the viscous contents. The calcified cyst wall did not yield to electrocautery or piecemeal fragmentation, until weakened by division and fragmentation using the pneumatic lithotripter. Partial cyst wall exicision/marsupialisation was complemented with omentoplasty. RESULTS No intraoperative or early postoperative complications occurred. The patient recovered well with little pain and was discharged early. This technique, in which the principles of percutaneous nephrolithotomy were applied for a special problem, is the first of its type. CONCLUSION Calcified renal hydatid cyst evacuation using the novel nephroscope-assisted retrieval of contents and lithotripter-assisted division of the calcified wall is a safe and feasible technique for total minimally invasive management.
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Affiliation(s)
- V SuryaPrakash
- Department of Urology and Renal Transplantation, Narayana Medical College, Nellore, Andhra Pradesh, India
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Abstract
The greatest disadvantage of conservative surgical procedures in the management of hydatid cyst of the liver is their association with high recurrence rates. Radical surgical procedures such as closed total pericystectomy avoids spillage thereby minimizing recurrences. The use of laparoscopy in performing these radical surgical procedures further reduces the morbidity associated with the open surgery. This study has been carried out to assess the safety and feasibility of laparoscopic pericystectomy in the management of hydatid cyst of liver. Small, peripherally located cysts lying away from major vessels are amenable to laparoscopic pericystectomy successfully whereas, cysts larger than 10 cm, posteriorly located cysts and those lying in close proximity to the major ducts and vessels required conversion owing to bleeding. Therefore, laparoscopic pericystectomy can be regarded as a gold standard for the management of hydatid cyst of the liver in selected patients.
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Laparoscopic fistula excision and omentoplasty for high rectovaginal fistulas: a prospective study of 40 patients. Int J Colorectal Dis 2011; 26:1463-7. [PMID: 21701809 PMCID: PMC3197910 DOI: 10.1007/s00384-011-1259-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2011] [Indexed: 02/04/2023]
Abstract
AIM The aim of this study is to prospectively evaluate 40 patients with a high rectovaginal fistula treated by a laparoscopic fistula division and closure, followed by an omentoplasty. PATIENTS AND METHODS Forty patients with a rectovaginal fistula, between the middle third of the rectum and the posterior vaginal fornix, resulting from different causes (IBD, iatrogenic and birth trauma) were treated by a laparoscopic excision of the fistula and insertion of an omentoplasty in the rectovaginal septum. The patients completed the gastrointestinal quality of life index questionnaire (GIQLI) and the Cleveland Clinic incontinence score (CCIS). All tests were performed at regular intervals after treatment. RESULTS In 38 (95%) patients with a median age of 53 years (range 33-72), the surgical procedure was feasible. In two patients, the fistula was closed without an omentoplasty, and a diverting stoma was performed. The median follow-up was 28 months (range 10-35). Two patients (5%) developed a recurrent fistula. In one patient, the interposed omentum became necrotic and was successfully treated laparoscopically. In another patient, an abscess developed, which needed drainage procedures. The mean CCIS was 9 (range 7-10) before treatment and 10 (range 7-13) after treatment (p = 0.5 Wilcoxon). The median GIQLI score was 85 (range 34-129) before treatment and 120 (range75-142) after treatment (p = 0.0001, Wilcoxon). CONCLUSIONS Laparoscopic fistula excision combined with omentoplasty is a good treatment modality with a high healing rate for high rectovaginal fistulas and an acceptable complication rate.
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Stoot JHMB, Jongsma CK, Limantoro I, Terpstra OT, Breslau PJ. More than 25 years of surgical treatment of hydatid cysts in a nonendemic area using the "frozen seal" method. World J Surg 2010; 34:106-13. [PMID: 19898895 PMCID: PMC2795857 DOI: 10.1007/s00268-009-0267-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Hydatid disease of the liver remains endemic in the world and is an imported disease in The Netherlands. The aim of this study was to evaluate the treatment and outcome of surgically treated patients for hydatid disease in a single center in The Netherlands. Methods This retrospective study included 112 consecutive patients surgically treated for hydatid disease between 1981 and 2007. The primary outcome was relapse of the disease. Secondary outcomes were infections, complications, reoperations, length of hospital stay, and mortality. Results In all cases, echinococcosis was diagnosed by computed tomography or ultrasonography (US). Serology (enzyme-linked immunosorbent assay, immunofluorescence) confirmed the diagnosis in 92.9%. Most of the cysts were seen only in the liver (73.5%). All cysts were operated on with the frozen seal technique. Relapse of disease was seen in 9 (8.0%) cases. Five (4.5%) required surgical treatment at a later stage. Twenty (17.9%) complications were recorded. Four (3.6%) needed radiological drainage and three (2.7%) a reoperation. Follow-up was performed with US and/or serology at a mean of 24 months (range 0.5–300 months). All but one complication were seen in the liver-operated group, this proved not to be of statistical significance (P = 0.477). Patients with complications stayed significantly longer in hospital than did the patients without complications (P < 0.001). No mortality was observed in this study. Conclusions The present study suggests that the frozen seal method of surgery for hydatid disease is safe and effective. Future studies are needed to prove its position in the treatment of hydatid disease as new developments show promising results.
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Affiliation(s)
- J H M B Stoot
- Department of Surgery, Maastricht University Medical Center, P. Debeylaan 25, Maastricht, The Netherlands.
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Pelvic hydatid (echinococcal) disease. Int J Gynaecol Obstet 2009; 109:45-8. [PMID: 20022597 DOI: 10.1016/j.ijgo.2009.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 09/29/2009] [Accepted: 11/23/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study epidemiologic and clinical features of pelvic hydatid disease and discuss its management. METHOD A retrospective analysis of 11 cases of pelvic hydatid disease managed over 7 years and 8 months at the Maternity and Neonatalogy Unit, Tunisian Medical Center La Rabta, Tunis, Tunisia. All cases were identified from histopathologic reports. RESULTS The 11 affected patients had a mean age of 41.6years (range, 22-79 years), 6 had a history of surgery for hydatid disease, 8 presented for chronic pelvic pain, and 1 was admitted for acute surgical abdomen. On physical examination, 6 had a pelvic mass. An ultrasound examination suggested the diagnosis preoperatively in 6. All were treated surgically. Primary laparoscopy was performed in 5 patients. Unroofing (or partial cystectomy) was performed in 6 patients and complete cystectomy in 4. The postoperative course was uneventful in all cases. Recurrence occurred only in 1 patient, 6 months after initial surgery. CONCLUSION Pelvic hydatid disease is rare and its diagnosis often difficult preoperatively. The treatment mainstay is surgery. The laparoscopic approach seems to be safe and effective, and may increasingly replace laparotomy.
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Laparoscopy for Liver Hydatid Disease: Where Do We Stand Today? Surg Laparosc Endosc Percutan Tech 2009; 19:419-23. [PMID: 20027080 DOI: 10.1097/sle.0b013e3181c30ed1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tekin A, Kartal A, Aksoy F, Vatansev C, Kücükkartallar T, Belviranli M, Sahin M, Yol S. Long-term results utilizing the unroofing technique in treating hydatid cysts of the liver. Surg Today 2008; 38:801-6. [PMID: 18751945 DOI: 10.1007/s00595-007-3720-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Accepted: 11/25/2007] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to present the long-term follow-up results of liver hydatid cysts treated with unroofing, together with a review of the related literature data. METHODS Of 700 liver hydatid cyst patients examined and treated at Selcuk University Meram Medical Faculty, General Surgery Department, between 1985 and 2007, 650 had accessible data and the unroofing method had been applied in 189 of them. The clinical and laboratory findings, stages, operations, and complications of patients treated with unroofing were reviewed. In particular, the resolution of residual cyst cavities over time after the application of this method was evaluated using computed tomography. RESULTS Four hundred and thirty-six (67.07%) of the cases were female [mean age: 35 (range: 10-73) years] and 214 (32.9%) were male [mean age: 46 (range: 12-76) years]. Of the 189 cases treated with unroofing and followed by tomography, the data of 144 were documented. Cavities were classified into five groups (A-E) according to their postoperative appearance. CONCLUSIONS Unroofing is an easy approach and it does not require extensive experience. This technique is recommended for peripherally localized cysts but may also be applied to those more deeply situated. Unroofing should be applied as deeply as possible and the residual cavity should also be as shallow as possible.
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Affiliation(s)
- Ahmet Tekin
- Department of General Surgery, Meram Medical Faculty, University of Selcuk, Akyokuş, Konya, Turkey
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Maazoun K, Mekki M, Chioukh FZ, Sahnoun L, Ksia A, Jouini R, Jallouli M, Krichene I, Belghith M, Nouri A. Laparoscopic treatment of hydatid cyst of the liver in children. A report on 34 cases. J Pediatr Surg 2007; 42:1683-6. [PMID: 17923196 DOI: 10.1016/j.jpedsurg.2007.05.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This study evaluated the safety and efficiency of laparoscopically treated liver cysts in children. METHODS From September 2001 to July 2004, 34 patients underwent laparoscopic treatment of hydatid cysts of the liver. All patients had chest x-ray, abdominal sonography, and hydatid serology. The different stages of the procedure were the same as in open surgery: puncture, aspiration, injection of scolicidal agent, reaspiration, removal of proligerous membrane, and resection of the dome. RESULTS The patients' mean average age was 7 years and 7 months (range, 3-14 years). The number of cysts ranged from 1 to 10 with a diameter of 40 to 150 mm (mean diameter, 65.5 mm). One case had a mesenteric associated hydatid cyst, another splenic hydatid cyst. The average length of hospital stay was 5 days (range, 4-14 days). No per- or postoperative complications were reported. At 12 to 45 months follow-up, no recurrence has been reported. CONCLUSION Laparoscopy represents an excellent approach for the treatment of hydatid cyst of the liver in children.
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Affiliation(s)
- Kais Maazoun
- Department of Pediatric Surgery, Fattouma Bourguiba Hospital, 5000 Monastir, Tunisia.
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Filippou D, Tselepis D, Filippou G, Papadopoulos V. Advances in liver echinococcosis: diagnosis and treatment. Clin Gastroenterol Hepatol 2007; 5:152-159. [PMID: 17157079 DOI: 10.1016/j.cgh.2006.08.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Echinococcosis or hydatid cyst disease is a zoonosis caused by the larval cestode Echinococcus granulosus. It consists of a parasitic tapeworm disease affecting mainly liver. Nevertheless, the disease might well spread to more unusual sites such as lungs and brain. The definitive diagnosis of liver echinococcosis requires a combination of imaging, serologic, and immunologic studies. Despite the fact that a number of scolecoidal agents have been developed against liver hydatid disease, the cornerstone of the definitive treatment remains surgery. Both the classic surgical techniques and the recently developed minimally invasive and laparoscopic methods target the eradication of the disease by simultaneously avoiding perioperative spillage and dissemination or recurrence of echinococcosis. The present article constitutes a review of the biology of the parasite as well as the epidemiology, diagnosis, and therapeutic options of the liver hydatid disease.
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Affiliation(s)
- Dimitrios Filippou
- First Department of General Surgery, Piraeus General Hospital Tzaneio, Piraeus, Athens, Greece.
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Palanivelu C, Senthilkumar R, Jani K, Rajan PS, Sendhilkumar K, Parthasarthi R, Rajapandian S. Palanivelu hydatid system for safe and efficacious laparoscopic management of hepatic hydatid disease. Surg Endosc 2006; 20:1909-1913. [PMID: 16960680 DOI: 10.1007/s00464-005-0274-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2005] [Accepted: 08/31/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hydatid disease, being endemic in several areas of the world, is of interest even to surgeons in non-endemic areas because they may encounter the disease due to ease and rapidity of travel as well as immigration. We describe a new device for laparoscopic management of hepatic hydatid disease. METHODS The special trocar-cannula system--the Palanivelu hydatid system (PHS)--and the technique of operation are described. A total of 75 patients were operated on using this technique. RESULTS In 83.3% of patients, only evacuation of the hydatid cyst by the PHS was done. In 13.7%, this was followed by left lobectomy because the cysts were large, occupying almost the entire left lobe of the liver. The remnant cavity was dealt with by omentoplasty. The average follow-up period was 5.9 years, during which there were no recurrences. CONCLUSIONS PHS is successful in preventing spillage, evacuating the contents of hydatid cysts, performing transcystic fenestration, and for dealing with cyst-biliary communications.
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Affiliation(s)
- C Palanivelu
- GEM Hospital, 45A, Pankaja Mill Road, Ramanathapuram, Coimbatore, Tamilnadu 641045, India
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Zerem E, Jusufovic R. Percutaneous treatment of univesicular versus multivesicular hepatic hydatid cysts. Surg Endosc 2006; 20:1543-1547. [PMID: 16897283 DOI: 10.1007/s00464-006-0135-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 04/30/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND Percutaneous drainage has been used successfully to treat hepatic hydatid cysts. This study aimed to analyze the results of this method in the treatment of univesicular and multivesicular hepatic hydatid cysts. METHODS Ultrasound-guided percutaneous drainage was used to treat 72 patients (44 women and 28 men; average age, 46.8 +/- 17.7 years) with hepatic hydatidosis. Of these 72 patients, 57 had one cyst, 7 had two cysts, and 8 had three cysts. Albendazole (10 mg per kg of body weight daily for 8 weeks) was administered to all the patients. Serial assessments included clinical and biochemical examinations, ultrasonography, and serologic tests for echinococcal antibody titers. RESULTS During the follow-up period, the mean cyst diameter decreased from 83.3 +/- 38.6 mm to 11.1 +/- 16.0 mm (p < 0.001) in the multivesicular group (27 cysts) and from 65.5 +/- 27.5 to 5.9 +/- 13.0 mm (p < 0.001) in the univesicular group (68 cysts). The final cyst diameter did not differ significantly between the two groups (p = 0.1). The findings showed that 81% of the cysts in the univesicular group and 63% in the multivesicular group disappeared (p = 0.12). The mean hospital stay was 4.8 +/- 2.9 days in the univesicular group and 6.1 +/- 4.7 days in the multivesicular group (p < 0.001). After an initial rise, the echinococcal-antibody titers fell progressively, and at the last follow-up evaluation were negative (<1:160) for 43 patients (94%) in the univesicular group and 19 patients (73%) in the multivesicular group (p = 0.03). Mild nonfatal complications were experienced by 24 patients (33%). CONCLUSIONS Percutaneous drainage combined with albendazole therapy is an effective and safe method for managing hydatid cysts of the liver that requires a short hospital stay. Disappearance of the cysts depends on cyst size. Multivesicular cysts have a more complicated course, a slower disappearance, and a higher incidence of positive echinococcal-antibody titers. Abscess formed after the procedure can be treated successfully by percutaneous drainage.
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Affiliation(s)
- E Zerem
- The Interventional Ultrasonography Department, University Clinical Center, Tuzla, Bosnia and Herzegovina
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Sandonato L, Cipolla C, Li Petri S, Ciacio O, Galia M, Cannizzaro F, Adelfio Latteri M. Giant Hepatic Hydatid Cyst as a Cause of Small Bowel Obstruction. Am Surg 2006. [DOI: 10.1177/000313480607200508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Today, giant hydatid cysts are fairly rare even in endemic areas. We describe a case of an extremely large hydatid cyst of the liver that was causing massive compression of the neighboring organs, giving rise to a subocclusive syndrome of the intestine. After considering the various approaches available for the treatment of this disease, it was decided that radical surgery was still the best therapeutic choice, especially when extremely large cysts are involved. In particular, in clinical situations where it is difficult to perform radical surgical procedures, less aggressive surgery followed by drug treatment should be the treatment of choice.
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Affiliation(s)
- Luigi Sandonato
- Departments of Oncology, Division of General and Oncological Surgery, University of Palermo, Interdepartmental Unit for Hepatic Neoplasia Group, Palermo, Italy
| | - Calogero Cipolla
- Departments of Oncology, Division of General and Oncological Surgery, University of Palermo, Interdepartmental Unit for Hepatic Neoplasia Group, Palermo, Italy
| | - Sergio Li Petri
- Departments of Oncology, Division of General and Oncological Surgery, University of Palermo, Interdepartmental Unit for Hepatic Neoplasia Group, Palermo, Italy
| | - Oriana Ciacio
- Departments of Oncology, Division of General and Oncological Surgery, University of Palermo, Interdepartmental Unit for Hepatic Neoplasia Group, Palermo, Italy
| | - Massimo Galia
- Departments of Radiology, University of Palermo, Interdepartmental Unit for Hepatic Neoplasia Group, Palermo, Italy
| | - Fabio Cannizzaro
- Departments of Radiology, University of Palermo, Interdepartmental Unit for Hepatic Neoplasia Group, Palermo, Italy
| | - Mario Adelfio Latteri
- Departments of Oncology, Division of General and Oncological Surgery, University of Palermo, Interdepartmental Unit for Hepatic Neoplasia Group, Palermo, Italy
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Canellada A, Cano E, Sánchez-Ruiloba L, Zafra F, Redondo JM. Calcium-dependent expression of TNF-α in neural cells is mediated by the calcineurin/NFAT pathway. Mol Cell Neurosci 2006; 31:692-701. [PMID: 16458016 DOI: 10.1016/j.mcn.2005.12.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 12/16/2005] [Accepted: 12/20/2005] [Indexed: 11/27/2022] Open
Abstract
We report induction of TNF-alpha via the calcium/calcineurin/NFAT pathway in PC12 neural cells. In PC12, expression of TNF-alpha mRNA, protein and TNF-alpha gene promoter activity was induced by co-stimulation with phorbol ester and either calcium ionophore A23187 or the L-type Voltage Gated Calcium Channel agonist Bay K 8644. Pre-treatment with calcineurin inhibitors CsA or FK506 inhibited the dominant calcium-dependent component of this induction, limiting it to the level achieved with phorbol ester alone. Promoter activation by Bay was abolished by nifedipine, a specific inhibitor of L-type Voltage Gated Calcium Channels. Exogenous NFAT protein transactivated the TNF-alpha promoter, and the peptide VIVIT-a specific inhibitor of calcineurin/NFAT binding-blocked calcium-inducible transactivation of the TNF-alpha promoter. Given proposed functions of TNF-alpha in spatial learning, memory and the pathogenesis of neurodegenerative diseases, the data presented suggest an important role for calcineurin/NFAT signaling in these key neurological processes.
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Affiliation(s)
- Andrea Canellada
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas (CBM-CSIC), Universidad Autónoma de Madrid (UAM), Facultad de Ciencias, Madrid 28049, Spain
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Borzellino G, Ruzzenente A, Minicozzi AM, Giovinazzo F, Pedrazzani C, Guglielmi A. Laparoscopic hepatic resection. Surg Endosc 2006; 20:787-90. [PMID: 16544083 DOI: 10.1007/s00464-004-2186-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2004] [Accepted: 06/10/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although laparoscopy in general surgery is increasingly being performed, only recently has liver surgery been performed with laparoscopy. We critically review our experience with laparoscopic liver resections. METHODS From January 2000 to April 2004, we performed laparoscopic hepatic resection in 16 patients with 18 hepatic lesions. Nine lesions were benign in seven patients (five hydatid cysts, three hemangiomas, and one simple cyst), five were malignant in five patients (five hepatocarcinoma), and four patients had an uncertain preoperative diagnosis (one suspected hemangioma and three suspected adenomas). The mean lesion size was 5.2 cm (range, 1-12). Twelve lesions were located in the left lobe, three were in segment VI, one was in segment V, one was in segment IV, and one was in the subcapsular part of segment VIII. RESULTS The conversion rate was 6.2%; intraoperative bleeding requiring blood transfusions occurred in two patients. Mean operative time was 120 min. Mean hospital stay was 4 days (range, 2-7). There were no major postoperative complications and no mortality. CONCLUSIONS Hepatic resection with laparoscopy is feasible in malignant and benign hepatic lesions located in the left lobe and anterior inferior right lobe segments (IV, V, and VI). Results are similar to those of the open surgical technique in carefully selected cases, although studies with large numbers of patients are necessary to drawn definite conclusions.
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Affiliation(s)
- G Borzellino
- First Department of General Surgery, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy.
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Mercan S. Cystic Parasitic and Nonparasitic Liver Disease. CONTROVERSIES IN LAPAROSCOPIC SURGERY 2006:273-282. [DOI: 10.1007/3-540-30964-0_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Dziri C, Haouet K, Zaouche A, Fingerhut A. Comment traiter un kyste hydatique du foie non compliqué ? ACTA ACUST UNITED AC 2005; 130:249-51. [PMID: 15847860 DOI: 10.1016/j.anchir.2005.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- C Dziri
- Service des urgences, hôpital Charles-Nicolle, boulevard du 9-avril-1938, 1006 Tunis, Tunisie.
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IPEG Guidelines for Surgical Treatment of Pediatric Spleen Diseases. J Laparoendosc Adv Surg Tech A 2005; 15:92-4. [PMID: 15772489 DOI: 10.1089/lap.2005.15.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Treatment of hydatid cyst of the liver ranges from surgical intervention (conventional or laparoscopic approach) to percutaneous drainage and to medical therapy. The aim of this systematic review was to provide "evidence-based" answers to the following questions: Should chemotherapy be used alone or in association with surgery? What is the best surgical technique? When is the percutaneous aspiration injection and reaspiration technique (PAIR) indicated? An extensive electronic search of the relevant literature without limiting it to the English language was carried out using MEDLINE and the Cochrane Library. Key words used for the final search were "hydatid cyst," "liver," "treatment," "meta analysis," "randomized controlled trial," "prospective study," "retrospective study." All relevant studies reporting the assessment of one modality of treatment or a comparison of two or several therapeutic methods to treat hydatid cyst of the liver and published in a peer-reviewed journal were considered for analysis. This systematic review allowed us to conclude that chemotherapy is not the ideal treatment for uncomplicated hydatid cysts of the liver when used alone (level II evidence, grade B recommendation). The level of evidence was too low to help decide between radical or conservative treatment (level IV evidence, grade C recommendation). Omentoplasty associated with radical or conservative treatment is efficient in preventing deep abscesses (level II evidence, grade A recommendation). The laparoscopic approach is safe (level IV evidence, grade C recommendation). Drug treatment associated with surgery (level II evidence, grade C recommendation) requires further studies. Percutaneous drainage associated with albendazole therapy is safe and efficient in selected patients (level II evidence, grade B recommendation). The level of evidence is low concerning treatment of complicated cysts.
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Giuliante F, D'Acapito F, Vellone M, Giovannini I, Nuzzo G. Risk for laparoscopic fenestration of liver cysts. Surg Endosc 2003; 17:1735-8. [PMID: 12802647 DOI: 10.1007/s00464-002-9106-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2002] [Accepted: 12/05/2002] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- F Giuliante
- Department of Surgical Sciences, Unit of Hepatobiliary and Digestive Surgery, Catholic University of Sacred Heart, School of Medicine, L.go A. Gemelli, 8, 00168 Rome, Italy.
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Buttenschoen K, Carli Buttenschoen D. Echinococcus granulosus infection: the challenge of surgical treatment. Langenbecks Arch Surg 2003; 388:218-30. [PMID: 12845535 DOI: 10.1007/s00423-003-0397-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2002] [Accepted: 05/21/2003] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cystic echinococcosis (CE) is a worldwide zoonosis caused by larval stages of the cestode Echinococcus granulosus. Surgery, chemotherapy, and interventional procedures are the therapeutic options. Surgery can cure the patient if the parasite is removed entirely. However, the technical procedures are inconsistent and comprise partial liver resection or opening of the parasitic cyst and removal of the parasite. Laparotomy is the most common approach. In selected cases laparoscopic methods are successful. Retrospective studies outweigh prospective ones by far. However, proper management gives favorable results. METHODS We critically review the literature and present a brief summary of current surgical strategy and focus on issues relevant for surgeons: diagnosis, indication for medical treatment, indication for surgical treatment, surgical procedures, scolicidal agents, morbidity, mortality, recurrence, perioperative medication, standards. RESULTS All surgical procedures aim at the complete removal of the parasite. Liver resection and pericystectomy are procedures that resect the closed cysts with a fairly wide safety margin. A meta-analysis shows the best results regarding lethality (1.2%), morbidity (11.7%), and recurrence rates (2%) for resective operations. However, most surgeons consider these methods as too radical for a benign disease. Procedures that remove the parasite and keep the pericyst (=cystectomy) are easier to carry out than resective ones. The meta-analysis presented revealed a lethality of 2%, morbidity of 23%, and recurrence rate of 10.4% for these operations. Omentoplasty is the option of choice for the management of the remaining cyst cavity. Despite alternative procedures surgery is the treatment of choice. Supportive measures comprise the use of scolicidal agents and postoperative benzimidazole administration. However, a critical review of the literature disclosed a lack of scientific confirmation of established treatment modalities and procedures. The results of ultrasound imaging were classified and correlated to the developmental phases of CE. CONCLUSIONS Cystectomy and omentoplasty for CE should be the standard surgical procedure because it is safe, simple, and effective and meets all criteria of surgical treatment for hydatid disease: entire elimination of the parasite, no intraoperative spillage especially by using a cone, and saving healthy tissue. Pericystectomy should be used for peripherally located liver cysts that are surrounded by parenchyma only partially. Ultrasonic classification of the parasitic lesion should be used as a guideline for therapeutic measures.
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Affiliation(s)
- K Buttenschoen
- Department of Surgery, University of Ulm, Steinhoevelstrasse 9, 89075 Ulm, Germany.
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Tampakoudis P, Assimakopoulos E, Zafrakas M, Tzevelekis P, Kostopoulou E, Bontis J. Pelvic echinococcus mimicking multicystic ovary. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 22:196-198. [PMID: 12905519 DOI: 10.1002/uog.172] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
An unusual case of pelvic echinococcus cyst is presented, appearing initially on transvaginal ultrasound as a pelvic mass mimicking a multicystic ovary. A similar mass in the liver raised preoperatively the suspicion of echinococcosis, making an open surgical procedure preferable to laparoscopy. Diagnosis was confirmed pathologically after removal of the cyst. Though their location in the pelvis is rare, echinococcal cysts should be considered in the differential diagnosis of pelvic masses, especially in patients from endemic areas. Evaluation of previous medical history and current symptoms, together with the ultrasonographic findings, is important for correct diagnosis and appropriate management.
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Affiliation(s)
- P Tampakoudis
- 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece
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Chowbey PK, Shah S, Khullar R, Sharma A, Soni V, Baijal M, Vashistha A, Dhir A. Minimal access surgery for hydatid cyst disease: laparoscopic, thoracoscopic, and retroperitoneoscopic approach. J Laparoendosc Adv Surg Tech A 2003; 13:159-65. [PMID: 12855097 DOI: 10.1089/109264203766207672] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Surgery has remained the mainstay for the treatment of hydatid cyst. The rapid development of laparoscopic techniques has encouraged surgeons to replicate principles of conventional hydatid surgery using a minimally invasive approach. Several reports have confirmed the feasibility of laparoscopic hepatic hydatid surgery. We report the use of a laparoscopic approach for cysts located in the liver, lung, and retroperitoneum. Fifteen patients with hydatid cysts, including one patient with a recurrent cyst, of various organs, including the liver, lung, and retroperitoneum, were operated on laparoscopically. Sixteen hydatid cysts were drained in a total of 15 patients. The mean operative time was 84 +/- 6 minutes (60-125 minutes). The mean duration of the hospital stay was 2.3 days (1-6 days). The mean cyst diameter was 9.2 cm (6.4-13.5 cm). No conversions to open surgery were required. One complication, a trocar-induced bowel perforation, occurred, and there was no mortality. During 3 to 44 months (mean, 27 months) of follow-up, no recurrences developed. Minimal access surgery is a safe, effective, and viable option for the management of selected patients with hydatid cysts in various locations, such as the liver, lung, and retroperitoneum.
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Affiliation(s)
- P K Chowbey
- Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India.
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Colle I, Van Vlierberghe H, Brenard R, Troisi R, de Hemptinne B, Navez B, De Coninck S, De Vos M. Biliary complications of large Echinococcus granulosus cysts: report of 2 cases and review of the literature. Acta Clin Belg 2002; 57:349-54. [PMID: 12723255 DOI: 10.1179/acb.2002.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hydatid cysts are often incidentally found and remain clinically silent. However complications can occur. We present 2 patients who developed biliary complications due to a large hydatid cyst. In the first patient compression on the intrahepatic bile ducts and cystic duct by the cyst, caused cholangitis and cholecystitis. Moreover the cyst had ruptured into the right intrahepatic bile ducts. A sphincterotomy was performed with extraction of hydatid sand. A pericystectomy was necessary because of infectious deterioration of the patient. Albendazole was continued for 8 weeks after surgery. The second case presented with jaundice and weight-loss since 1 month. A large hydatid cyst caused compression on the bile duct bifurcation with proximal bile duct dilatation. A cystectomy was performed 2 weeks after albendazole therapy initiation, which was continued for 8 weeks after surgery. Follow-up of both surgical interventions was unremarkable. Although Echinococcus granulosus in not prevalent in Belgium, we must be aware of this pathology in patients coming from high endemic regions.
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Affiliation(s)
- I Colle
- Department of Hepato-Gastroenterology, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
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