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Alzoubi M, Daradkeh S, Daradka K, Shattarat LN, Al-Zyoud A, Al-Qalqili LA, Al-Warafi WA, Al-Nezaa I, ElMoubarek MN, Qtaishat L, Rawashdeh B, Alhajahjeh A. The recurrence rate after primary resection cystic echinococcosis: A meta-analysis and systematic literature review. Asian J Surg 2024:S1015-9584(24)02081-5. [PMID: 39343686 DOI: 10.1016/j.asjsur.2024.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/01/2024] [Accepted: 09/05/2024] [Indexed: 10/01/2024] Open
Abstract
Cystic echinococcosis (CE) is a chronic, complex, zoonotic disease caused by Echinococcus Granulose tapeworms. The disease may present with a variety of symptoms, ranging from asymptomatic to fatal. Surgical intervention is the primary treatment modality for CE. Despite advances in surgical techniques and chemotherapy, disease recurrence remains a major concern. Therefore, we aimed to determine the true rate of CE recurrence after primary resection and identify possible factors that increase the risk of recurrence. A systematic search of Medline, PubMed, Embase, and Cochran Library was conducted to identify studies reporting the incidence of CE recurrence after primary radical surgery. Data were pooled using random effect models. The disease prevalence was determined by calculating the ratio of CE recurrence and the total number of patients. A meta-regression was conducted to identify any potential factors linked to recurrence. A total of 38 eligible studies, with a total of 6,222 CE patients who underwent primary surgical removal, revealed a pooled recurrence rate of 8% (95% CI: 6%-10%). However, significant heterogeneity was observed (I2 p-value <0.001). Subgroup analysis by region showed the highest incidence of recurrence in European and Turkish studies, with rates of 11% (95% CI: 7%-17%) and 9% (95% CI: 5%-14%), respectively. The lowest recurrence rate was observed in Asian studies, with a rate of 4% (95% CI: 2%-7%). Moreover, the non-radical intervention has a recurrence of 5% (95%CI: 4%-7%), radical 7% (95%CI: 6%-9%), and studies that contained both interventions have 10% (95%CI: 6%-16%), P-value= 0.04. This is the first meta-analysis to evaluate the overall incidence of CE recurrence after primary surgical removal. The study also revealed a substantial degree of heterogeneity across the included studies and indicated possible risk factors for higher recurrence rates, such as the study's geographic area, type of surgery and the year it was published. These findings will help to guide future research in developing effective strategies to prevent or reduce CE recurrence and improve patient outcomes.
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Affiliation(s)
| | - Salam Daradkeh
- The University of Jordan, General Surgery Department, Jordan.
| | - Khaled Daradka
- The University of Jordan, General Surgery Department, Jordan.
| | | | - Asma Al-Zyoud
- The University of Jordan, School of Medicine, Jordan.
| | | | | | | | | | - Leen Qtaishat
- The University of Jordan, School of Medicine, Jordan.
| | | | - Abdulrahman Alhajahjeh
- The University of Jordan, School of Medicine, Jordan; King Hussein Cancer Center (KHCC), Internal Medicine Department, Jordan.
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Kuehn R, Uchiumi LJ, Tamarozzi F. Treatment of uncomplicated hepatic cystic echinococcosis (hydatid disease). Cochrane Database Syst Rev 2024; 7:CD015573. [PMID: 38994714 PMCID: PMC11240857 DOI: 10.1002/14651858.cd015573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
BACKGROUND Cystic echinococcosis is a parasitic infection mainly impacting people living in low- and middle-income countries. Infection may lead to cyst development within organs, pain, non-specific symptoms or complications including abscesses and cyst rupture. Treatment can be difficult and varies by country. Treatments include oral medication, percutaneous techniques and surgery. One Cochrane review previously assessed the benefits and harms of percutaneous treatment compared with other treatments. However, evidence for oral medication, percutaneous techniques and surgery in specific cyst stages has not been systematically investigated and the optimal choice remains uncertain. OBJECTIVES To assess the benefits and harms of medication, percutaneous and surgical interventions for treating uncomplicated hepatic cystic echinococcosis. SEARCH METHODS We searched CENTRAL, MEDLINE, two other databases and two trial registries to 4 May 2023. We searched the reference lists of included studies, and contacted experts and researchers in the field for relevant studies. SELECTION CRITERIA We included randomized controlled trials (RCTs) in people with a diagnosis of uncomplicated hepatic cystic echinococcosis of World Health Organization (WHO) cyst stage CE1, CE2, CE3a or CE3b comparing either oral medication (albendazole) to albendazole plus percutaneous interventions, or to surgery plus albendazole. Studies comparing praziquantel plus albendazole to albendazole alone prior to or following an invasive intervention (surgery or percutaneous treatment) were eligible for inclusion. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were symptom improvement, recurrence, inactive cyst at 12 months and all-cause mortality at 30 days. Our secondary outcomes were development of secondary echinococcosis, complications of treatment and duration of hospital stay. We used GRADE to assess the certainty of evidence. MAIN RESULTS We included three RCTs with 180 adults and children with hepatic cystic echinococcosis. Two studies enrolled people aged 5 to 72 years, and one study enrolled children aged 6 to 14 years. One study compared standard catheterization plus albendazole with puncture, aspiration, injection and re-aspiration (PAIR) plus albendazole, and two studies compared laparoscopic surgery plus albendazole with open surgery plus albendazole. The three RCTs were published between 2020 and 2022 and conducted in India, Pakistan and Turkey. There were no other comparisons. Standard catheterization plus albendazole versus PAIR plus albendazole The cyst stages were CE1 and CE3a. The evidence is very uncertain about the effect of standard catheterization plus albendazole compared with PAIR plus albendazole on cyst recurrence (risk ratio (RR) 3.67, 95% confidence interval (CI) 0.16 to 84.66; 1 study, 38 participants; very low-certainty evidence). The evidence is very uncertain about the effects of standard catheterization plus albendazole on 30-day all-cause mortality and development of secondary echinococcosis compared to open surgery plus albendazole. There were no cases of mortality at 30 days or secondary echinococcosis (1 study, 38 participants; very low-certainty evidence). Major complications were reported by cyst and not by participant. Standard catheterization plus albendazole may increase major cyst complications compared with PAIR plus albendazole, but the evidence is very uncertain (RR 10.74, 95% CI 1.39 to 82.67; 1 study, 53 cysts; very low-certainty evidence). Standard catheterization plus albendazole may make little to no difference on minor complications compared with PAIR plus albendazole, but the evidence is very uncertain (RR 1.03, 95% CI 0.60 to 1.77; 1 study, 38 participants; very low-certainty evidence). Standard catheterization plus albendazole may increase the median duration of hospital stay compared with PAIR plus albendazole, but the evidence is very uncertain (4 (range 1 to 52) days versus 1 (range 1 to 15) days; 1 study, 38 participants; very low-certainty evidence). Symptom improvement and inactive cysts at 12 months were not reported. Laparoscopic surgery plus albendazole versus open surgery plus albendazole The cyst stages were CE1, CE2, CE3a and CE3b. The evidence is very uncertain about the effect of laparoscopic surgery plus albendazole on cyst recurrence in participants with CE2 and CE3b cysts compared to open surgery plus albendazole (RR 3.00, 95% CI 0.13 to 71.56; 1 study, 82 participants; very low-certainty evidence). The second study involving 60 participants with CE1, CE2 or CE3a cysts reported no recurrence in either group. The evidence is very uncertain about the effect of laparoscopic surgery plus albendazole on 30-day all-cause mortality in participants with CE1, CE2, CE3a or CE3b cysts compared to open surgery plus albendazole. There was no mortality in either group (2 studies, 142 participants; very low-certainty evidence). The evidence is very uncertain about the effect of laparoscopic surgery plus albendazole on major complications in participants with CE1, CE2, CE3a or CE3b cysts compared to open surgery plus albendazole (RR 0.50, 95% CI 0.13 to 1.92; 2 studies, 142 participants; very low-certainty evidence). Laparoscopic surgery plus albendazole may lead to slightly fewer minor complications in participants with CE1, CE2, CE3a or CE3b cysts compared to open surgery plus albendazole (RR 0.13, 95% CI 0.02 to 0.98; 2 studies, 142 participants; low-certainty evidence). Laparoscopic surgery plus albendazole may reduce the duration of hospital stay compared with open surgery plus albendazole (mean difference (MD) -1.90 days, 95% CI -2.99 to -0.82; 2 studies, 142 participants; low-certainty evidence). Symptom improvement, inactive cyst at 12 months and development of secondary echinococcosis were not reported. AUTHORS' CONCLUSIONS Percutaneous and surgical interventions combined with albendazole can be used to treat uncomplicated hepatic cystic echinococcosis; however, there is a scarcity of randomised evidence directly comparing these interventions. There is very low-certainty evidence to indicate that standard catheterization plus albendazole may lead to fewer cases of recurrence, more major complications and similar complication rates compared to PAIR plus albendazole in adults and children with CE1 and CE3a cysts. There is very low-certainty evidence to indicate that laparoscopic surgery plus albendazole may result in fewer cases of recurrence or fewer major complications compared to open surgery plus albendazole in adults and children with CE1, CE2, CE3a and CE3b cysts. Laparoscopic surgery plus albendazole may lead to slightly fewer minor complications. Firm conclusions cannot be drawn due to the limited number of studies, small sample size and lack of events for some outcomes.
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Affiliation(s)
- Rebecca Kuehn
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Leonardo J Uchiumi
- Control Program of Cystic Echinococcosis, Ministry of Health, Río Negro Province, Viedma, Argentina
| | - Francesca Tamarozzi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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Gishto T, Simoni L, Gina M, Shuka N, Methoxha S. Hepatic Hydatid Cyst Presenting as Right-Sided Heart Failure: A Case Report. Cureus 2024; 16:e55726. [PMID: 38586784 PMCID: PMC10998657 DOI: 10.7759/cureus.55726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Cystic echinococcosis is a parasitic disease caused by Echinococcus granulosus. The transmission of the parasite to dogs occurs when organs of animals that harbor hydatid cysts are consumed. We present the case of a patient presented in the cardiology outpatient clinic with the signs and symptoms of predominant right-sided heart failure. Upon evaluation, a large hepatic septated cyst was revealed, which was compressing the right chambers of the heart, altering diastolic filling, and causing right-sided heart failure. CT scan confirmed the presence of a hydatid cyst measuring 115 mm × 90 mm. The patient underwent surgical excision of the cyst with immediate relief of the symptoms. Two weeks later, the patient presented again with the same symptoms and was diagnosed with a recurrence of the hydatid cyst. He underwent surgical resection and removal of the cyst again. The patient remained asymptomatic and free of recurrence on further follow-up evaluations. Cardiac echinococcosis typically features intra-myocardial cysts, while our case presented an extracardiac location. Extrinsic compression of the heart's right chambers from a hydatid cyst has been rarely reported. The surgical excision of the cyst brings immediate and full resolution of the symptoms. The recurrence of hydatid cysts is also an important clinical feature that should not be underestimated.
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Affiliation(s)
- Taulant Gishto
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Leonard Simoni
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Mirald Gina
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Naltin Shuka
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Silvia Methoxha
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
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Mahmoodpour H, Spotin A, Hatam GR, PourmahdiGhaemmaghami A, Sadjjadi SM. In vitro and ex vivo protoscolicidal effects of hydroalcoholic extracts of Eucalyptus microtheca on protoscoleces of Echinococcus granulosus sensu stricto: A light and scanning electron microscopy (SEM) study. Exp Parasitol 2023:108553. [PMID: 37230322 DOI: 10.1016/j.exppara.2023.108553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Cystic echinococcosis (CE) is one of the most widespread and important global helminth zoonoses. Treatment relies mainly on surgery and, or percutaneous interventions. However, spillage of live protoscoleces (PSCs) leading to recurrence is a problem during surgery. So, the application of protoscolicidal agents before surgery is required. This study aimed to investigate the activity and safety of hydroalcoholic extracts of E. microtheca against PSCs of Echinococcus granulosus sensu stricto (s.s.) both in vitro and also ex vivo, which is a simulation to Puncture, Aspiration, Injection, and Re-aspiration (PAIR) method. METHODS Considering the effects of heat on the protoscolicidal effecacy of Eucalyptus leaves, hydroalcoholic extraction was performed by both soxhlet extraction at 80 °C and percolation at room temperature. The protoscolicidal action of hydroalcoholic extracts was assessed by in vitro and ex vivo assessments. Infected sheep livers were collected from the slaughterhouse. Then, the genotype of hydatid cysts (HCs) was confirmed by sequencing and, isolates were limited to E. granulosus s.s. In the next step, ultrastructural changes of Eucalyptus-exposed PSCs were studied by scanning electron microscopy (SEM). Finally, a cytotoxicity test was conducted by (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay to evaluate the safety of E. microtheca. RESULTS The prepared extracts by soxhlet extraction and percolation were, successfully exerted strong protoscolicidal effects in both in vitro and ex vivo tests. The results of in vitro assessment indicated that hydroalcoholic extract of E. microtheca prepared by percolation at room temperature (EMP) and hydroalcoholic extract of E. microtheca prepared by soxhlet extraction at 80 °C (EMS) killed all PSCs (100%) at concentrations of 10 and 12.5 mg/mL, respectively. Also, EMP showed 99% protoscolicidal action after 20 min in an ex vivo setting compared to EMS. SEM micrographs confirmed potent protoscolicidal and destructive effects of E. microtheca against PSCs. The cytotoxicity of EMP was tested on the Hela cell line using MTT assay. The value of 50% cytotoxic concentration (CC50) was calculated at 46.5 μg/mL after 24h. CONCLUSION Both hydroalcoholic extracts showed potent protoscolicidal activity and, especially EMP produced remarkable protoscolicidal effects compared to the control group.
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Affiliation(s)
- Hamid Mahmoodpour
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Adel Spotin
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Gholam Reza Hatam
- Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Seyed Mahmoud Sadjjadi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Pompili M, Ardito F, Brunetti E, Cabibbo G, Calliada F, Cillo U, de Sio I, Golfieri R, Grova M, Gruttadauria S, Guido M, Iavarone M, Manciulli T, Pagano D, Pettinari I, Santopaolo F, Soresi M, Colli A. Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d'Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) - Part I - Cystic lesions. Dig Liver Dis 2022; 54:1469-1478. [PMID: 36089525 DOI: 10.1016/j.dld.2022.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/29/2022]
Abstract
Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the first part of the guideline, concerning the characterization of focal hepatic lesions detected by ultrasound, and the diagnosis and clinical management of simple and parasitic hepatic cysts, and of polycystic liver disease.
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Affiliation(s)
- Maurizio Pompili
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy.
| | - Francesco Ardito
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy
| | - Enrico Brunetti
- Dipartimento di Scienze Cliniche, Chirurgiche, Diagnostiche e Pediatriche, IRCCS Fondazione Ospedale San Matteo, Università di Pavia, Unità di Malattie Infettive e Immunologia, Pavia, Italy
| | - Giuseppe Cabibbo
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Fabrizio Calliada
- Dipartimento di Radiologia, Fondazione Policlinico San Matteo IRCCS, Università di Pavia, Italy
| | - Umberto Cillo
- Chirurgia Epatobiliare e Trapianto di Fegato, Ospedale Universitario di Padova, Italy
| | - Ilario de Sio
- Epatogastroenterologia, Facoltà di Medicina e Chirurgia, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Rita Golfieri
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Mauro Grova
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Salvatore Gruttadauria
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT-UPMCI, Dipartimento di Chirurgia e Specialità Medico-Chirurgiche, Università di Catania, Palermo, Italy
| | - Maria Guido
- Dipartimento di Anatomia Patologica, Azienda ULSS2 Marca Trevigiana, Treviso, Italy; Dipartimento di Medicina - DIMED, Università di Padova, Italy
| | - Massimo Iavarone
- Divisione di Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tommaso Manciulli
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | - Duilio Pagano
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT-UPMC, Palermo, Italy
| | - Irene Pettinari
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Francesco Santopaolo
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy
| | - Maurizio Soresi
- Medicina Interna, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Farhat W, Ammar H, Rguez A, Harrabi F, Said MA, Ghabry L, Gupta R, Ben Cheikh A, Ghali H, Ben Rajeb M, Ben Mabrouk M, Ben Ali A. Radical versus conservative surgical treatment of liver hydatid cysts: A paired comparison analysis. Am J Surg 2022; 224:190-195. [PMID: 34949334 DOI: 10.1016/j.amjsurg.2021.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/14/2021] [Accepted: 12/14/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The management of liver hydatid cysts (LHC) is complex and includes surgery, percutaneous drainage, chemotherapy and observation. Broadly, there are two types of surgical treatment for LHC - conservative surgery (CS) and radical surgery (RS). The purpose of this study was to compare the outcome of RS and CS. METHODS Data from all patients with LHC treated in Sahloul Hospital, between January 2000 and December 2019, were retrieved. To minimize selection bias, paired comparison analysis (PCA) was performed. RESULTS A total of 914 patients were included in this study. RS and CS were performed in 284 and 630 patients, respectively. After PCA, 206 patients were included in each group. The incidence of intraoperative bleeding was significantly higher in the RS group. The overall morbidity was significantly lower in the RS group. Thity-four patients developed recurrence with significantly higher recurrence in CS group. CONCLUSION RS is associated with fewer postoperative complications and lower recurrence rate compared to CS. RS may be the preferred procedure for LHC if the expertise is available.
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Affiliation(s)
- Waad Farhat
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Arib Rguez
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Fathia Harrabi
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Mohamed Amine Said
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Linda Ghabry
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India.
| | - Asma Ben Cheikh
- Department of Prevention and Security of Care, Sahloul Hospital, Sousse, Tunisia.
| | - Hela Ghali
- Department of Prevention and Security of Care, Sahloul Hospital, Sousse, Tunisia.
| | - Mohamed Ben Rajeb
- Department of Prevention and Security of Care, Sahloul Hospital, Sousse, Tunisia.
| | | | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
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Kırış MT, Ergün S, Akıncı O, Ergin S, Velidedeoğlu M, Kocazeybek BS, Göksoy E. Evaluation of <em>Echinococcus</em> DNA by polymerase chain reaction (PCR) in cystic <em>Echinococcosis</em> of the liver. Turk J Surg 2022; 38:196-201. [PMID: 36483165 PMCID: PMC9714648 DOI: 10.47717/turkjsurg.2022.5427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this study was to determine the DNA and genotypes of Echinococcus granulosus in liver cyst hydatids isolated in humans. MATERIAL AND METHODS This study was conducted prospectively at the Department of General Surgery of the Cerrahpaşa School of Medicine, University of İstanbul-Cerrahpaşa, between January 2015 and June 2016 in 30 patients who were operated on for cystic Echinococcosis. E. granulosus DNA was analyzed using the Polymerase Chain Reaction (PCR) method in the cyst samples (protoscolex and/or germinative membrane) obtained during the operation, and genotype was determined in the PCR positive samples by sequence analysis. At the same time, indirect hemagglutination (IHA) was used to test for the presence of antibodies in the patients' blood. RESULTS E. granulosus DNA was found in 29 out of 30 cystic Echinococcosis of the liver samples. All of the 29 cystic Echinococcosis samples were found to be G1 (sheep) species. Also, IHA was positive in 22 patients and negative in eight patients. CONCLUSION In the present study, G1 species was the most commonly seen liver cystic Echinococcosis species. We suggest that a vaccine, which could be developed against prevalent regional genotypes, would be efficacious in the prevention of the disease with a cause of mortality and morbidity.
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Affiliation(s)
- Mehmet Tolga Kırış
- Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Sefa Ergün
- Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Ozan Akıncı
- Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Sevgi Ergin
- Department of Medical Microbiology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Mehmet Velidedeoğlu
- Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Bekir Sami Kocazeybek
- Department of Medical Microbiology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Ertuğrul Göksoy
- Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
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8
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Öztürk G, Uzun MA, Özkan ÖF, Kayaalp C, Tatlı F, Eren S, Aksungur N, Çoker A, Bostancı EB, Öter V, Kaya E, Taşar P. Turkish HPB Surgery Association consensus report on hepatic cystic Echinococcosis (HCE). Turk J Surg 2022; 38:101-120. [PMID: 36483170 PMCID: PMC9714645 DOI: 10.47717/turkjsurg.2022.5757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cystic Echinococcosis (CE) is one of the important problems of the Eurasian region. We aimed to prepare a consensus report in order to update the treatment approaches of this disease. This study was conducted by Turkish HPB Surgery Association. MATERIAL AND METHODS This study was conducted with the modified Delphi model. For this purpose, we conducted a three-stage consensus-building approach. RESULTS Six topics, including diagnosis, medical treatment, percutaneous treatment, surgical treatment, management of complications and posttreatment follow-up and recurrences in HCE were discussed. CONCLUSION The expert panel made recommendations for every topic.
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Affiliation(s)
- Gürkan Öztürk
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Mehmet Ali Uzun
- Clinic of General Surgery, Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Türkiye
| | - Ömer Faruk Özkan
- Clinic of General Surgery, Ümraniye Education and Research Hospital, İstanbul, Türkiye
| | - Cüneyt Kayaalp
- Department of General Surgery, Yeditepe University Faculty of Medicine, İstanbul, Türkiye
| | - Faik Tatlı
- Department of General Surgery, Harran University Faculty of Medicine, Şanlıurfa, Türkiye
| | - Suat Eren
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Nurhak Aksungur
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Ahmet Çoker
- Clinic of General Surgery, Medicana International İzmir Hospital, İzmir, Türkiye
| | | | - Volkan Öter
- Clinic of Gastroenterological Surgery, Ankara State Hospital, Ankara, Türkiye
| | - Ekrem Kaya
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Pınar Taşar
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
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Tamarozzi F, Manciulli T, Brunetti E, Vuitton DA. Echinococcosis. HELMINTH INFECTIONS AND THEIR IMPACT ON GLOBAL PUBLIC HEALTH 2022:257-312. [DOI: 10.1007/978-3-031-00303-5_8] [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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Salah EB, Barrera C, Mosbahi S, Gottstein B, Siles-Lucas M, Belhassen S, Nouri A, Babba H, Millon L, Sakly W. Promising proteins detected by Western blot from Echinococcus granulosus protoscoleces for predicting early post-surgical outcomes in CE-affected Tunisian children. Parasit Vectors 2021; 14:180. [PMID: 33781311 PMCID: PMC8008569 DOI: 10.1186/s13071-021-04679-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/11/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cystic echinococcosis (CE) affects predominantly young patients in highly endemic areas. Improved serological methods are needed for the follow-up of CE cases, especially given the high rates of post-surgical relapse that require detection as soon as possible. METHODS We designed a study to investigate the value of antigenic proteins extracted from Echinococcus granulosus (E. granulosus) protoscoleces, and of recombinant B2t and 2B2t proteins, for assessing the efficacy of surgical treatment carried out on CE-affected children. This study was performed on 278 plasma samples collected from 59 Tunisian children surgically treated for CE and monitored for 3 years post-surgery. The patients were classified according to post-surgical outcomes into a "non-relapsed" (NRCE) and a "relapsed" (RCE) group. We performed in-house ELISAs to measure anti-B2t and anti-2B2t IgG and immunoblotting for the detection of IgG against SDS-PAGE-resolved E. granulosus protoscoleces-specific antigens. The Wilcoxon test was applied to assess anti-B2t and anti-2B2t IgG levels. We applied the Cochran Q test to compare the distribution of immunoblotting antigenic bands between 1-month and 1-year post-surgery. RESULTS The probability of being "relapse-free" when a decrease in antibody titers occurred between 1 month and 1 year post-surgery was 81% and 75%, respectively, for anti-B2t and anti-2B2t IgG. We identified five protoscolex protein bands of 20, 26/27, 30, 40 and 46 kDa as highly immunoreactive by immunoblot for both RCE and NRCE patients at 1 month post-surgery, and significantly lower immunoreactivity after 1 year (p < 10-4) for NRCE compared to RCE patients. The proteins at 26/27 and 40 kDa displayed the best performance in predicting the outcome, with an 84% probability of being relapse-free when the reactivity against the 40 kDa antigen, the doublet at 26/27 kDa, or both was absent or disappeared between 1 month and 1 year post-surgery, and a 93% probability of being relapsed when both bands remained reactive or increased in intensity between the two time points. CONCLUSIONS The B2t protein could be useful for the prediction of CE early post-surgical outcomes. The proteins of E. granulosus protoscoleces, especially the doublet P26/27 and P40, could be promising predictive biomarkers for the post-surgical follow-up of CE cases as well.
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Affiliation(s)
- Eya Ben Salah
- Département de Biologie Clinique B, Faculté de Pharmacie, Laboratoire de Parasitologie-Mycologie Médicale Et Moléculaire, LR12ES08, Université de Monastir, 1 Rue Avicenne, 5000, Monastir, Tunisie
| | - Coralie Barrera
- Department of Parasitology Mycology, University Hospital of Besançon, UMR/CNRS 6249 Chrono-Environnement Research Team, University of Bourgogne- Franche-Comté, Besançon, France
| | - Sana Mosbahi
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Medical School , Monastir, Tunisia
| | - Bruno Gottstein
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, 3001, Bern, Switzerland
| | - Mar Siles-Lucas
- Instituto de Recursos Naturales Y Agrobiología de Salamanca (IRNASA-CSIC), 37008, Salamanca, España
| | - Samia Belhassen
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Medical School , Monastir, Tunisia
| | - Abdellatif Nouri
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Medical School , Monastir, Tunisia
| | - Hamouda Babba
- Département de Biologie Clinique B, Faculté de Pharmacie, Laboratoire de Parasitologie-Mycologie Médicale Et Moléculaire, LR12ES08, Université de Monastir, 1 Rue Avicenne, 5000, Monastir, Tunisie
| | - Laurence Millon
- Department of Parasitology Mycology, University Hospital of Besançon, UMR/CNRS 6249 Chrono-Environnement Research Team, University of Bourgogne- Franche-Comté, Besançon, France
| | - Wahiba Sakly
- Département de Biologie Clinique B, Faculté de Pharmacie, Laboratoire de Parasitologie-Mycologie Médicale Et Moléculaire, LR12ES08, Université de Monastir, 1 Rue Avicenne, 5000, Monastir, Tunisie.
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Ben Salah E, Sakly W, Barrera C, Mosbahi S, Bellanger AP, Farhani R, Ksia A, Gottstein B, Nouri A, Babba H, Millon L. Soluble programmed death-1 (sPD-1) as predictor of early surgical outcomes of paediatric cystic echinococcosis. Parasite Immunol 2020; 43:e12809. [PMID: 33207012 DOI: 10.1111/pim.12809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Abstract
AIMS Following treatment, cystic echinococcosis (CE) exhibits a relatively high relapse rate. Here, we evaluated the value of soluble programmed death-1 (sPD-1), sPD-1 ligand (sPD-L1) and anti-recP29 antibody concentrations, as predictors of early surgical treatment outcomes in young CE-affected patients. METHODS AND RESULTS This prospective study included 59 Tunisian children (177 plasmas), where CE was surgically treated and monitored for 3 post-operative years. Based on CE post-surgical development, patients were clustered into a 'No relapsed' CE (NRCE; n = 39) and a 'Relapsed' CE (RCE; n = 20) group. Plasma levels of sPD-1, sPD-L1 and anti-recP29 IgG were measured using ELISA. In the NRCE group, sPD-1, sPD-L1 and anti-recP29 IgG concentrations were significantly lower at D365 than at D30. By contrast, in the RCE group, no significant difference was observed between D0, D30 and D365. When considering individual variations, the probability to be 'relapse-free' was 67% and 73% when anti-recP29 IgG and sPD-L1 level, respectively, decreased between D30 and D365. The probability to be 'relapse-free' was 86% when the sPD-1 level decreased between D30 and D365 (P = .003; chi-square test). CONCLUSION sPD-1 may be a useful biomaker for the early evaluation of surgical procedure efficacy in paediatric CE cases.
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Affiliation(s)
- Eya Ben Salah
- Departement de Biologie clinique B, Faculté de Pharmacie, Laboratoire de Parasitologie-Mycologie Médicale et Moléculaire, LR12ES08, Université de Monastir, Monastir, Tunisia
| | - Wahiba Sakly
- Departement de Biologie clinique B, Faculté de Pharmacie, Laboratoire de Parasitologie-Mycologie Médicale et Moléculaire, LR12ES08, Université de Monastir, Monastir, Tunisia
| | - Coralie Barrera
- Department of Parasitology Mycology, University Hospital of Besançon, UMR/CNRS 6249 Chrono-Environnement Research Team, University of Bourgogne, Franche-Comté, France
| | - Sana Mosbahi
- Paediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Medical School, Tunisia
| | - Anne-Pauline Bellanger
- Department of Parasitology Mycology, University Hospital of Besançon, UMR/CNRS 6249 Chrono-Environnement Research Team, University of Bourgogne, Franche-Comté, France
| | - Rabeb Farhani
- Paediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Medical School, Tunisia
| | - Amine Ksia
- Paediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Medical School, Tunisia
| | - Bruno Gottstein
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Abdellatif Nouri
- Paediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Medical School, Tunisia
| | - Hamouda Babba
- Departement de Biologie clinique B, Faculté de Pharmacie, Laboratoire de Parasitologie-Mycologie Médicale et Moléculaire, LR12ES08, Université de Monastir, Monastir, Tunisia
| | - Laurence Millon
- Department of Parasitology Mycology, University Hospital of Besançon, UMR/CNRS 6249 Chrono-Environnement Research Team, University of Bourgogne, Franche-Comté, France
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Surgical management of hepatic hydatid cysts - conservative versus radical surgery. HPB (Oxford) 2020; 22:1457-1462. [PMID: 32229090 DOI: 10.1016/j.hpb.2020.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/10/2020] [Accepted: 03/01/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgical management is considered one of the effective treatment modality for liver hydatid. However the choice of surgery is debatable. This study aims to compare the outcome of radical surgery (RS) and conservative surgery (CS) in liver hydatid disease. METHODS This is retrospective analysis of prospectively maintained institutional data of surgically treated liver hydatid from January 2012 to January 2019. The basis of diagnosis was typical imaging, confirmatory Hydatid serology and/or Intraoperative details. The clinical presentation, radiological data, operative detail, post-operative outcome, post-operative recurrence data was analysed. RESULTS Sixty-four patients underwent surgery during the study period and were included. RS was done in 27 (42.2%) patients and CS in 37 (57.8%) patients. The mean age was 35.6 (13-72) years. The mean size of the cyst was 10.3 ± 2.9 cm. The cyst location was peripheral in 81.5% and 56.8% in RS and CS groups respectively. Intraoperative Cyst biliary communication was detected in 48.1% of RS & 35.1% in CS group of patients. The post-operative bile leak was significantly less in RS group (7.4% vs 27.0%, p = 0.047). Postoperative endoscopic stenting for persistent biliary fistula was necessitated in five of CS and only one patient from RS group. None of RS patients had recurrence while 3 patients of CS developed recurrence. CONCLUSION Radical surgery reduces post-operative bile leak and prevents recurrence and may be preferable to conservative surgery.
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Tilioua S, Mezioug D, Amir-Tidadini ZC, Medjdoub YM, Touil-Boukoffa C. Potential role of NF-κB pathway in the immuno-inflammatory responses during human cystic echinococcosis. Acta Trop 2020; 203:105306. [PMID: 31891707 DOI: 10.1016/j.actatropica.2019.105306] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 11/08/2019] [Accepted: 12/16/2019] [Indexed: 01/03/2023]
Abstract
Cystic echinococcosis (CE) induces in the human host innate and adaptive immune response that plays an important role in controlling the immunopathogenesis. Due to the crucial role of nuclear factor kappa B (NF-κB) in regulating immuno-inflammatory processes, we investigated its potential contribution in systemic and local immuno-inflammatory responses in primary CE patients and relapsed patients. The expression of NF-κB and inducible nitric oxide synthase (iNOS) was analyzed in peripheral blood mononuclear cells (PBMC) as well as in pericystic layer of pulmonary hydatid cysts from Algerian primary CE patients and relapsed patients. Tumor necrosis factor alpha (TNF-α) and nitric oxide (NO) production was evaluated in plasma samples. Our results showed high iNOS and NF-κB expression in both PBMCs and pericystic histiocytes from primary CE patients. In addition, substantial amounts of systemic NO and TNF-α were detected in the same patients. Remarkably, relapsed patients exhibited a low NF-κB and iNOS expression associated with low amounts of plasmatic TNF-α and NO. Collectively, NF-κB/iNOS pathway is involved in the host defense mechanisms at the systemic and local level during primary CE. Our results indicate that the inhibition of this pathway in relapsed patients will attenuate protective immunity and promote parasite escape. This study allowed to identify a novel predictive biomarkers of hydatidosis.
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Dulundu E. Management of Hepatic Echinococcal Disease and Its Complications. THE SURGICAL MANAGEMENT OF PARASITIC DISEASES 2020:129-141. [DOI: 10.1007/978-3-030-47948-0_8] [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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Aday U, Böyük A. Spillage and recurrence in surgical management of hydatid cyst of the liver. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.620672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sokouti M, Sadeghi R, Pashazadeh S, Abadi SEH, Sokouti M, Ghojazadeh M, Sokouti B. A systematic review and meta-analysis on the treatment of liver hydatid cyst using meta-MUMS tool: comparing PAIR and laparoscopic procedures. Arch Med Sci 2019; 15:284-308. [PMID: 30899281 PMCID: PMC6425195 DOI: 10.5114/aoms.2018.73344] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/20/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There is an academic debate over surgical treatments of liver hydatid cyst disease. In this study, a systematic review and meta-analysis were carried out in order to evaluate the pros and cons of both PAIR (Puncture, Aspiration, Injection, Respiration) and laparoscopic techniques by considering the outcomes of liver hydatid cysts. MATERIAL AND METHODS We designed descriptive Boolean queries to search two databases, PubMed and Scopus, to derive the articles published in the period of January 2000 to December 2016 in order to evaluate the outcomes of these research articles. The outcomes of laparoscopic and PAIR procedures include the rates of cure, postoperative complications, recurrences, and mortality, which were extracted, assessed, and used as their corresponding effect sizes. RESULTS Fifty-seven studies including a total of 2832 patients (PAIR group n = 1650 and laparoscopic group = 1182) were analyzed. In this meta-analysis study, a random effect model of correlations of outcomes (postoperative complications, mortalities, recurrences, and cure rates) of PAIR and laparoscopy procedures was used. The meta-analysis and the forest plots of the two procedures show that the PAIR approach is superior in terms of cure, complication, and mortality rates compared with the laparoscopy technique. However, the recurrence rate is low in laparoscopic approaches. Moreover, Egger's tests for determining publication bias and heterogeneity tests were also performed. CONCLUSIONS This study shows promising trends toward an advantage of PAIR procedures in treatment of liver hydatid cyst in comparison with laparoscopic procedures. The PAIR procedure is superior to laparoscopy due to having a higher cure rate and lower complication and mortality rates; however, the latter has a lower recurrence rate.
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Affiliation(s)
- Massoud Sokouti
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Pashazadeh
- Department of Computer and Electrical Engineering, University of Tabriz, Tabriz, Iran
| | - Saeed Eslami Hasan Abadi
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Sokouti
- Department of Cardiothoracic Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Sokouti
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Bektasoglu HK, Hasbahceci M, Tasci Y, Aydogdu I, Malya FU, Kunduz E, Dolay K. Comparison of Laparoscopic and Conventional Cystotomy/Partial Cystectomy in Treatment of Liver Hydatidosis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1212404. [PMID: 30868067 PMCID: PMC6379859 DOI: 10.1155/2019/1212404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/19/2018] [Accepted: 01/17/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hydatidosis is a zoonotic infection and treatment is mandatory to avoid complications. Surgery remains the first choice in the treatment especially for CE2-CE3b cysts. Open or laparoscopic approaches are available. However, comparative studies are limited. MATERIALS AND METHODS Data of patients who underwent cystotomy/partial cystectomy for liver hydatidosis between January 2012 and September 2016 (n=77) were evaluated retrospectively. Recurrent cases and the patients with previous hepatobiliary surgery were excluded. 23 patients were operated upon laparoscopically and named as Group 1. 48 patients operated conventionally named as Group 2. Demographics, cyst characteristics, operative time, length of hospital stay, recurrences, and surgery related complications were evaluated. RESULTS Groups were similar in terms of demographics, cyst characteristics, and operative time. The length of hospital stay was 3.4 days in Group 1 and 4.7 days in Group 2 (p=0,007). The mean follow-up period was 17.8 months and 21.7 months, respectively (p=0.170). Overall complication rates were similar in two groups (p=0.764). Three conversion cases occurred (13%). One mortality was seen in Group 2. Four recurrences occurred in each group (17% versus 8.3%, respectively) (p=0.258). CONCLUSIONS Laparoscopy is a safe and feasible approach for surgical treatment of liver hydatidosis. Recurrence may be prevented by selection of appropriate cases in which exposure of cysts does not pose an intraoperative difficulty.
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Affiliation(s)
- Huseyin Kazim Bektasoglu
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Vatan Street, Fatih, 34093 Istanbul, Turkey
| | - Mustafa Hasbahceci
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Vatan Street, Fatih, 34093 Istanbul, Turkey
| | - Yunus Tasci
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Vatan Street, Fatih, 34093 Istanbul, Turkey
| | - Ibrahim Aydogdu
- Department of Pediatric Surgery, Faculty of Medicine, Bezmialem Vakif University, Vatan Street, Fatih, 34093 Istanbul, Turkey
| | - Fatma Umit Malya
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Vatan Street, Fatih, 34093 Istanbul, Turkey
| | - Enver Kunduz
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Vatan Street, Fatih, 34093 Istanbul, Turkey
| | - Kemal Dolay
- Department of General Surgery, Liv Hospital Ulus, Istinye University, Besiktas, 34340 Istanbul, Turkey
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Temiz A, Öztürk G, Kısaoğlu A, Korkut E, Karadeniz E. Factors related to recurrence in surgical treatment of hydatid cyst. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.434719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Affiliation(s)
- Carlos Manterola
- Department of Surgery; Universidad de La Frontera; Temuco Chile
- Center of Morphological and Surgical Studies; Universidad de La Frontera; Temuco Chile
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Keong B, Wilkie B, Sutherland T, Fox A. Hepatic cystic echinococcosis in Australia: an update on diagnosis and management. ANZ J Surg 2017; 88:26-31. [PMID: 29024292 DOI: 10.1111/ans.14117] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Ben Keong
- Department of Upper Gastrointestinal Surgery; St George Hospital; Sydney New South Wales Australia
| | - Bruce Wilkie
- Department of Surgery; Eastern Health; Melbourne Victoria Australia
| | - Tom Sutherland
- Medical Imaging Department; St Vincent's Hospital; Melbourne Victoria Australia
| | - Adrian Fox
- Department of Surgery; Eastern Health; Melbourne Victoria Australia
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Sokouti M, Sadeghi R, Pashazadeh S, Abadi SEH, Sokouti M, Rezaei-Hachesu P, Ghojazadeh M, Sokouti B. A systematic review and meta-analysis on the treatment of liver hydatid cyst: Comparing laparoscopic and open surgeries. Arab J Gastroenterol 2017; 18:127-135. [PMID: 28988788 DOI: 10.1016/j.ajg.2017.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/29/2017] [Accepted: 09/17/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND STUDY AIMS There is an academic debate regarding surgical interventions for liver hydatid cyst disease. The purpose of the current systematic review and meta-analysis study was to analyse the pros and cons of open surgery and laparoscopic techniques, considering the outcomes of liver hydatid cysts. METHODS Descriptive Boolean queries were used to search PubMed and Scopus for articles published between January 2000 and December 2016 to evaluate the outcomes of liver hydatid cyst in terms of mortality, post-operative complications, cure rate and recurrences. The data related to the four outcomes of liver hydatid cyst were extracted, assessed and then used as their corresponding effect sizes in the meta-analysis process. RESULTS Six studies totally consisting of 1028 patients [open surgery group=816 (+7 converted to lap) and laparoscopic group=212] were analysed. In this meta-analysis study, random effects models of outcomes (i.e. post-operative complications, mortalities, recurrences and cure rate) of the two procedures were OR=0.852, LL=0.469, UL=1.546, Z=-0.526, p=0.599 (for post-operative complications); OR=0.849, LL=0.141, UL=5.105, Z=-0.179, p=0.858 (for mortality); OR=0.903, LL=0.166, UL=4.906, Z=-0.119, p=0.906 (for recurrence); and OR=0.459, LL=0.129, UL=1.637, Z=-1.201, p=0.230 (for cure rate). Meta-analysis and illustrated forest plots showed that there are no superiorities between the two approaches. The results of heterogeneity tests of the above mentioned outcomes were Q=8.083, df=5, p=0.152, I2=38.142% for post-operative complications; Q=0.127, df=2, p=0.938, I2=0% for mortality; Q=4.984, df=2, p=0.083, I2=59.874% for recurrence; and Q=10.639, df=5, p=0.059, I2=53.001% for cure rate. The results of regression tests based on Egger's, smoothed variance based on Egger (SVE) and smoothed variance based on Thomson (SVT) showed that the p values are not significant, and there are neither significant statistical differences nor publication bias between the outcomes of the two treatment procedures. CONCLUSION The results show no promising trends towards advantages of open versus laparoscopic surgeries in the treatment of liver hydatid cyst. However, informative measurement values for comparing these surgeries could be derived for complications, recurrence, mortality and cure rates. Furthermore, all three tests, namely Egger's, SVE and SVT regression models, were used to assess publication bias and showed no evidence for the existence of publication bias.
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Affiliation(s)
- Massoud Sokouti
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Saeid Pashazadeh
- Faculty of Computer and Electrical Engineering, University of Tabriz, Tabriz, Iran
| | - Saeed Eslami Hasan Abadi
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Sokouti
- Department of Cardiothoracic Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Peyman Rezaei-Hachesu
- Department of Health Information Technology, School of Health Management and Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Sokouti
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Velasco-Tirado V, Romero-Alegría Á, Belhassen-García M, Alonso-Sardón M, Esteban-Velasco C, López-Bernús A, Carpio-Perez A, Jimenez López MF, Muñoz Bellido JL, Muro A, Cordero-Sanchez M, Pardo-Lledias J, Muñoz-Bellvis L. Recurrence of cystic echinococcosis in an endemic area: a retrospective study. BMC Infect Dis 2017; 17:455. [PMID: 28655301 PMCID: PMC5488421 DOI: 10.1186/s12879-017-2556-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/16/2017] [Indexed: 01/20/2023] Open
Abstract
Background Cystic echinococcosis (CE) is a chronic, complex and neglected zoonotic disease. CE occurs worldwide. In humans, it may result in a wide spectrum of clinical manifestations, ranging from asymptomatic infection to fatal disease. Clinical management procedures have evolved over decades without adequate evaluation. Despite advances in surgical techniques and the use of chemotherapy, recurrence remains one of the major problems in the management of hydatid disease. The aim of this study was to determine the frequency of CE recurrence and the risk factors involved in recurrence. Methods A descriptive longitudinal-retrospective study was designed. We reviewed all patients diagnosed with CE according to ICD-9 (code 122–0 to 122–9) criteria admitted at Complejo Asistencial Universitario de Salamanca, Spain, between January 1998 and December 2015. Results Among the 217 patients studied, 25 (11.5%) had a hydatid recurrence after curative intention treatment. Median duration of recurrence’s diagnosis was 12.35 years (SD: ±9.31). The likelihood of recurrence was higher [OR = 2.7; 95% CI, 1.1–7.1; p < 0.05] when the cyst was located in organs other than liver and lung, 22.6% (7/31) vs 14.2% (31/217) in the cohort. We detected a chance of recurrence [OR = 2.3; 95% CI, 1.4–6.5; p > 0.05] that was two times higher in those patients treated with a combination of antihelminthic treatments and surgical intervention (20/141, 14.2%) than in patients treated with surgical intervention alone (5/76, 6.6%). Conclusions Despite advances in diagnosis and therapeutic techniques in hydatid disease, recurrence remains one of the major problems in the management of hydatid disease. The current management and treatment of recurrences is still largely based on expert opinion and moderate-to-poor quality of evidence. Consequently, large prospective and multicenter studies will be needed to provide definitive recommendations for its clinical management.
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Affiliation(s)
- Virginia Velasco-Tirado
- Servicio de Dermatologia Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Paseo San Vicente, Salamanca, Spain
| | - Ángela Romero-Alegría
- Servicio de Medicina Interna, CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Paseo San Vicente, 58-182, 37007, Salamanca, Spain
| | - Moncef Belhassen-García
- Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Paseo San Vicente, 58-182, 37007, Salamanca, Spain.
| | | | | | | | | | | | | | - Antonio Muro
- Laboratorio de Inmunología Parasitaria y Molecular, CIETUS, IBSAL, Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| | - Miguel Cordero-Sanchez
- Servicio de Medicina Interna, Seccion de Enfermedades Infecciosas, CAUSA, CIETUS, IBSAL, Universidad de Salamanca, Salamanca, Spain
| | - Javier Pardo-Lledias
- Servicio de Medicina Interna, Hospital General de Palencia "Río Carrión", C/ Donantes de Sangre, Palencia, Spain
| | - Luis Muñoz-Bellvis
- Servicio de Cirugia, CAUSA, IBSAL, Universidad de Salamanca, Salamanca, Spain
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Kahriman G, Ozcan N, Dogan S, Karaborklu O. Percutaneous treatment of liver hydatid cysts in 190 patients: a retrospective study. Acta Radiol 2017; 58:676-684. [PMID: 27565632 DOI: 10.1177/0284185116664226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Hydatid liver disease (HLD) is a significant health problem, especially in endemic areas worldwide. Percutaneous treatment is an effective alternative therapeutic option. Purpose To present the clinical and radiological results of percutaneous treatment of HLD in 190 patients. Material and Methods Percutaneous treatment of HLD between April 2005 and March 2015 was analyzed retrospectively. The demographic data, numbers and types of cysts, initial and final volumes of the cysts, types of percutaneous treatment, and procedure-related complications were determined. Results A total of 190 patients (95 male patients and 95 female patients; age range, 5-82 years) with 283 liver hydatid cysts who underwent percutaneous treatment were included in the study. Of the 283 cysts, 234 (83%) were cystic echinococcosis CE1, 31 (11%) were CE3a, and 18 (6%) were CE2 cysts, according to the World Health Organization (WHO) classification. The percutaneous procedure was successful in all patients. A total of 12 (6.3%) major complications, including anaphylaxis, allergic skin reaction, perihepatic hemorrhage, and cavity infection, were seen. No mortality was noted. Recurrence in one patient and an additional cyst in one patient were seen. All patients were asymptomatic during the follow-up period. Mean volume reduction was 77.5%, with a mean follow-up period of 18 months. Conclusion Percutaneous treatment is an effective and safe method for the treatment of HLD. It should be regarded as a first-line treatment method for uncomplicated hydatid cysts.
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Affiliation(s)
- Guven Kahriman
- Department of Radiology, University of Erciyes, School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Nevzat Ozcan
- Department of Radiology, University of Erciyes, School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Serap Dogan
- Department of Radiology, University of Erciyes, School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Oguz Karaborklu
- Department of Radiology, University of Erciyes, School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
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Pascal G, Azoulay D, Belghiti J, Laurent A. Hydatid disease of the liver. BLUMGART'S SURGERY OF THE LIVER, BILIARY TRACT AND PANCREAS, 2-VOLUME SET 2017:1102-1121.e3. [DOI: 10.1016/b978-0-323-34062-5.00074-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Mihmanli M, Idiz UO, Kaya C, Demir U, Bostanci O, Omeroglu S, Bozkurt E. Current status of diagnosis and treatment of hepatic echinococcosis. World J Hepatol 2016; 8:1169-1181. [PMID: 27729953 PMCID: PMC5055586 DOI: 10.4254/wjh.v8.i28.1169] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 07/11/2016] [Indexed: 02/06/2023] Open
Abstract
Echinococcus granulosus (E. granulosus) and Echinococcus multilocularis (E. multilocularis) infections are the most common parasitic diseases that affect the liver. The disease course is typically slow and the patients tend to remain asymptomatic for many years. Often the diagnosis is incidental. Right upper quadrant abdominal pain, hepatitis, cholangitis, and anaphylaxis due to dissemination of the cyst are the main presenting symptoms. Ultrasonography is important in diagnosis. The World Health Organization classification, based on ultrasonographic findings, is used for staging of the disease and treatment selection. In addition to the imaging methods, immunological investigations are used to support the diagnosis. The available treatment options for E. granulosus infection include open surgery, percutaneous interventions, and pharmacotherapy. Aggressive surgery is the first-choice treatment for E. multilocularis infection, while pharmacotherapy is used as an adjunct to surgery. Due to a paucity of clinical studies, empirical evidence on the treatment of E. granulosus and E. multilocularis infections is largely lacking; there are no prominent and widely accepted clinical algorithms yet. In this article, we review the diagnosis and treatment of E. granulosus and E. multilocularis infections in the light of recent evidence.
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Affiliation(s)
- Memmet Mihmanli
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
| | - Ufuk Oguz Idiz
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
| | - Cemal Kaya
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
| | - Uygar Demir
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
| | - Ozgur Bostanci
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
| | - Sinan Omeroglu
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
| | - Emre Bozkurt
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
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Ibrahim HH. Hepatic hydatid cysts. Eur Surg 2016. [DOI: 10.1007/s10353-016-0431-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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El Malki HO, Souadka A, Serji B, Benkabbou A, Mohsine R, Ifrine L, Belkouchi A. Radical Surgery for Liver Hydatid Cyst. JOURNAL OF MEDICAL AND SURGICAL RESEARCH 2014. [DOI: 10.46327/msrjg.1.000000000000011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and aims: Surgery is the basic treatment for liver hydatid cyst (LHC). Radical procedures (pericystectomy (PK) and hepatic resection (HR)) offers better results in selected cases cases than conservative approaches. Aims of this study were to evaluate the results of Radical surgery for LHC and and to determine witch of these two procedures is safe in experienced hepato-biliary surgical unit in endemic countries.
Methods: A retrospective cohort study of 143 patients with liver hydatid cyst who underwent radical procedures at a single surgical department in an endemic country were reviewed. Mortality, morbidity and recurrence rates have been analyzed.
Results: Thirty-two patients (22.4%) had a HR and 111 patients (77.6%) had a PK. Mortality rate was 1.4% (n=2) in HR group. Overall morbidity rate was 18.9% and vs 28.1% respectively in PK and HR group (p=.26). Postoperative bleeding occurred in 1.8% in PK group vs 3.1% in HR group (p=.535) and specific LHC operative complication occurred in 17.1% in PK group vs 28.1% in HR group (p=.167). Recurrence rate of LHC was 6.3% in PK group vs 6.6% in HR group (p=.999) after a median follow up of 108 months (54-144) vs 89 months (44-135) respectively.
Conclusion: Radical surgery for LHC is safe. Each of PK and HR had a specific indication. A good screening of patient's guarantied a good outcome.
Keywords: Liver, Hydatid Cyst, Morocco, Radical Surgery.
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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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Manterola C, Otzen T, Urrutia S. Risk factors of postoperative morbidity in patients with uncomplicated liver hydatid cyst. Int J Surg 2014; 12:695-9. [PMID: 24859488 DOI: 10.1016/j.ijsu.2014.05.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/15/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine postoperative morbidity (POM) in patients undergoing surgery for uncomplicated hepatic echinococcosis (HE) and determine associations with the variable POM looking for possible risk factors for POM. METHODS Nested case-control study. We included patients undergoing surgery for uncomplicated HE in two hospitals in Temuco between 2000 and 2012. The main outcome variable was development of POM. Other variables of interest were hospital stay, mortality and recurrence. Surgical techniques used were pericystectomy and liver resection. Descriptive statistics and analytical statistics were applied using T-test, ANOVA and Kruskal-Wallis test to compare continuous variables; Chi(2) and Fisher's exact test for categorical variables, and logistic regression models were used, estimating OR. RESULTS 126 patients, median age 41 years, 61% female. The incidence of POM was 10.3%, with 76.9% Clavien grade I or II. The etiology was 6.5% and 4.1% of medical and surgical complications, respectively. There was no mortality and with a median follow-up of 83 months, recurrence incidence was 0.8%. Association was found between cases and controls and the variables age, alkaline phosphatase, cyst location and hospital stay. Applying regression models age (p = 0.002 and OR 1.07) and cyst location (p = 0.003 and OR 3.94) were found to be risk factors. CONCLUSIONS Observed POM is lower and of less severity than those previously published. Risk factors were determined.
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Affiliation(s)
- Carlos Manterola
- Department of Surgery, Faculty of Medicine, Universidad de La Frontera, Manuel Montt 112, Office 408, Temuco, Chile; Center for Biomedical Research, Universidad de Autónoma, Chile.
| | - Tamara Otzen
- PhD Program in Medical Sciences, Universidad de La Frontera, Temuco, Chile; Department of Psychology, Universidad Autónoma, Temuco, Chile
| | - Sebastián Urrutia
- Department of Surgery, Faculty of Medicine, Universidad de La Frontera, Manuel Montt 112, Office 408, Temuco, Chile
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Rinaldi F, Brunetti E, Neumayr A, Maestri M, Goblirsch S, Tamarozzi F. Cystic echinococcosis of the liver: A primer for hepatologists. World J Hepatol 2014; 6:293-305. [PMID: 24868323 PMCID: PMC4033287 DOI: 10.4254/wjh.v6.i5.293] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/22/2014] [Accepted: 03/18/2014] [Indexed: 02/06/2023] Open
Abstract
Cystic echinococcosis (CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptomatic infection to severe, potentially fatal disease. Four approaches exist in the clinical management of CE: surgery, percutaneous techniques and drug treatment for active cysts, and the ”watch and wait” approach for inactive cysts. Allocation of patients to these treatments should be based on cyst stage, size and location, available clinical expertise, and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated. This paper reviews recent advances in classification and diagnosis and the currently available evidence for clinical decision-making in cystic echinococcosis of the liver.
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The adventitia resection in treatment of liver hydatid cyst: a case report of a 15-year-old boy. Case Rep Surg 2014; 2014:123149. [PMID: 24782939 PMCID: PMC3982247 DOI: 10.1155/2014/123149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 01/05/2014] [Indexed: 11/25/2022] Open
Abstract
Human hydatid disease is a significant health problem in endemic regions caused by the larval form of Echinococcus granulosus. In this paper, we report a case of liver hydatid cyst. The patient, a 15-year-old boy, presented with a history of intermittent upper abdominal pain of a few-month duration was referred to our hospital for investigation. Computed tomographic scan and laboratory test suggested a hydatid cyst in the right lobe of liver. The adventitia resection of hydatid cyst was smoothly performed as there was a less bloody virtual space between adventitia and outer membrane. Our diagnosis was made using an imaging approach and was confirmed during surgery. We proposed the adventitia resection of hydatid cyst could be safe and easy to perform with low risk of bleeding and bile leakage.
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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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Surgical treatment of giant liver hydatid cysts: comparison of cystojejunostomy and partial cystectomy. Surg Today 2014; 44:2065-71. [PMID: 24664490 DOI: 10.1007/s00595-014-0887-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/28/2013] [Indexed: 01/13/2023]
Abstract
PURPOSE The aim of this study was to compare partial cystectomy and internal drainage of the cyst cavity with cystojejunostomy for the surgical treatment of giant hepatic hydatid cysts. METHODS Patients who underwent any type of surgical treatment between March 2009 and May 2013 for giant hepatic hydatid cysts were retrospectively evaluated. The data collected included demographic variables, diagnostic methods, surgical procedures, morbidity and mortality rates. RESULTS Twenty-eight patients who underwent surgery for giant hepatic hydatid cysts were included. There were 16 (57 %) female patients, with a mean age of 32.8 years. The diagnostic methods primarily included abdominal ultrasonography and computed tomography, which were performed in 62 % of the patients. The patients were divided into two groups with respect to the treatment modality: Group A (n = 13) treated with cystojejunostomy and Group B (n = 15) treated with partial cystectomy. The overall rate of cavity-related complications was 25 % in Group B, whereas none of the patients in Group A had a cavity-related complication during the follow-up period (p < 0.05). CONCLUSION Cystojejunostomy is an effective and safe surgical approach for the treatment of giant hepatic hydatid cysts, with a lower rate of morbidity than partial cystectomy, and thus may be the surgical treatment of choice for giant hepatic hydatid cysts.
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Is the Adjuvant Albendazole Treatment Really Needed with PAIR in the Management of Liver Hydatid Cysts? A Prospective, Randomized Trial with Short-Term Follow-Up Results. Cardiovasc Intervent Radiol 2014; 37:1568-74. [DOI: 10.1007/s00270-014-0840-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 12/07/2013] [Indexed: 01/01/2023]
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Lv H, Li S, Zhang J, Liang W, Mu X, Jiang Y. In vitro effects of SB202190 on Echinococcus granulosus. THE KOREAN JOURNAL OF PARASITOLOGY 2013; 51:255-8. [PMID: 23710097 PMCID: PMC3662073 DOI: 10.3347/kjp.2013.51.2.255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/14/2012] [Accepted: 12/01/2012] [Indexed: 12/19/2022]
Abstract
Spillage of cyst contents during surgical operation is the major cause of recurrence after hydatid cyst surgery. Instillation of a scolicidal agent into a hepatic hydatid cyst is the most commonly employed measure to prevent this complication. SB202190 is a pyridinyl imidazole derivative and is known to be a specific inhibitor of p38 MAPK. In the present study, the scolicidal effect of SB202190 was investigated. Freshly isolated Echinococcus granulosus protoscolices were subjected to SB202190 treatment (10, 20, 40, and 80 µM), and the effects on parasite viability were monitored by trypan blue staining. Corresponding effects were visualized by scanning and transmission electron microscopy. Dose-dependent protoscolex death within a few days of SB202190 treatment was observed. Although the in vitro scolicidal effect of SB202190 was satisfactory, the in vivo efficacy of this drug and also possible side effects remain to be further investigated.
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Affiliation(s)
- Hailong Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
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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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Is hepatic resection the best treatment for hydatid cyst? J Gastrointest Surg 2012; 16:2086-93. [PMID: 22903365 DOI: 10.1007/s11605-012-1993-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/06/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hydatid disease is a serious public health problem in endemic areas, and the management is controversial. Operative treatment is generally accepted especially in patients presenting complications. Our policy is to perform radical surgery and, whenever possible, anatomic hepatic resection. The purpose is to report our experience and results in the management of liver hydatid disease. METHODS Between January 1991 and December 2010, 97 patients were referred to our department for surgical treatment of hepatic hydatid cyst. Data were retrospectively reviewed. Patients were divided into three treatment groups: conservative surgery (CS), total pericystectomy (PC), and hepatic resection (HR). The main outcome measures were the mortality, morbidity, and recurrence rate. RESULTS Median patient age was 45 years (range, 30-56 years). A total of 105 hydatid cysts were treated. Radical surgery was performed in 85 patients: major HR in 43 patients, minor HR in 9, and total PC in 33. CS was performed in 12 cases. There were no postoperative deaths, and the overall morbidity was 20 %. Postoperative morbidity in the HR group was 20 %. Minor (Grade I/II) and major (Grade III/IV) complications were comparable between groups (p = ns). No statistical difference in duration of hospitalization was observed between the CS and the HR group. One patient in the HR group developed a recurrence. CONCLUSIONS The findings of this study suggest that surgical resection is not associated with much more postoperative and cyst cavity-related complications than the other groups. In addition, there was no mortality and a low recurrence rate.
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Re: Di Benedetto et al.: Isolated large hydatid cyst in the kidney of an elderly man (Urology 2012;79:e47-e48). Urology 2012; 80:232-3; author reply 233-4. [PMID: 22748886 DOI: 10.1016/j.urology.2012.01.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 01/25/2012] [Accepted: 01/27/2012] [Indexed: 11/20/2022]
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Prousalidis J, Kosmidis C, Anthimidis G, Kapoutzis K, Karamanlis E, Fachantidis E. Postoperative recurrence of cystic hydatidosis. Can J Surg 2012; 55:15-20. [PMID: 21939605 DOI: 10.1503/cjs.013010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Surgical management is the basic treatment for hydatid disease. Overall, the recurrence rate appears to be high (4.6%-22.0%). The purpose of this study was to report our results in the management of recurrent hydatid disease, evaluating the methods for identifying recurrence, prognostic factors and therapeutic options. METHODS We retrospectively reviewed the medical records of patients who underwent surgery for cystic hydatidosis between 1970 and 2003. RESULTS Of the 584 patients who underwent surgery during our study period, follow-up was complete for 484 (82.8%). Cysts recurred in 51 patients (8.7%). Abdominal ultrasonography and computed tomography appeared to be efficient for diagnosing recurrence. The 2 most important determinants for recurrence were minute spillage of the hydatid cyst and inadequate treatment owing to missing cysts or incomplete pericystectomy. All but 2 recurrences required surgery. There were 14 postoperative complications for a rate of 27.0%. Thirteen re-recurrences were observed in the follow-up of these patients and also required surgery. CONCLUSION Avoidance of minute spillage of cyst contents and cautious removal of the parasite with as much of the pericyst as possible are fundamental objectives of primary-hydatid surgery. Conservative surgery (removal of the cyst contents plus partial pericystectomy with drainage when necessary) plus chemotherapy and local sterilization is suggested for both primary and secondary operations and appears to achieve satisfactory longterm results. Radical surgery (resection, cystopericystectomy) is preferred only in select patients.
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Affiliation(s)
- John Prousalidis
- Department of Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Prieto M, Marquina T, Mifsut P, Moreno T. Hidatidosis esplénica: 5 casos de esta rara localización. Enferm Infecc Microbiol Clin 2011; 29:634-5. [DOI: 10.1016/j.eimc.2011.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 04/22/2011] [Accepted: 04/27/2011] [Indexed: 11/29/2022]
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Kahriman G, Ozcan N, Donmez H. Hydatid cysts of the liver in children: percutaneous treatment with ultrasound follow-up. Pediatr Radiol 2011; 41:890-4. [PMID: 21607599 DOI: 10.1007/s00247-011-2088-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 12/12/2010] [Accepted: 12/31/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hydatid disease is a serious public health problem in endemic areas. Percutaneous treatment is an effective alternative to surgical and medical therapy in hydatid liver disease (HLD). OBJECTIVE To present clinical and radiological results of percutaneous treatment of HLD in children. MATERIALS AND METHODS Twenty-five children (16 males; age range, 5-15 years; mean age, 9.6 years) with a total of 30 hydatid cysts of the liver underwent ultrasound US guided percutaneous treatment using hypertonic saline as the scolicidal agent. RESULTS The percutaneous procedure was successful in all patients. All children were asymptomatic at follow-up. A hypersensitivity reaction occurred in one child (4%) during the procedure. No other complications occurred. The reduction in cyst volume was 14-100% (mean, 64%) at follow-up (mean 13.8 months). On US at follow-up, the treated cysts were semisolid with a heterogeneous echo pattern (n = 17), solid hypoechoic (n = 10) or solid with calcification (n = 2). One treated cyst disappeared sonographically. CONCLUSION Percutaneous treatment of HLD is effective, safe and well-tolerated in children.
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Affiliation(s)
- Guven Kahriman
- Department of Radiology, School of Medicine, Gevher Nesibe Hospital, University of Erciyes, 38039, Kayseri, Turkey.
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Diagnosis and management against the complications of human cystic echinococcosis. ACTA ACUST UNITED AC 2010; 4:394-8. [DOI: 10.1007/s11684-010-0180-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 11/09/2010] [Indexed: 01/14/2023]
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Does primary surgical management of liver hydatid cyst influence recurrence? J Gastrointest Surg 2010; 14:1121-7. [PMID: 20464525 DOI: 10.1007/s11605-010-1220-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 04/28/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS Hydatid disease is still a major health problem in sheep-raising areas. Surgery remains the basic treatment for liver hydatid cyst (LHC). However, recurrences can occur after all therapies. Surgery for recurrence of LHC becomes technically more difficult with higher rate of morbidity and mortality. The aim of this study was to determine perfective factors associated to hepatic recurrence after LHC surgery and to propose and discuss postoperative follow-up schedules. METHODS It is a retrospective cohort study of 672 patients with LHC treated at the surgery department "A" at Ibn Sina University Hospital, Rabat, Morocco, from January 1990 to December 2004. Recurrence rates have been analyzed by the Kaplan-Meier method for patients undergoing surgery. RESULTS Fifty-six patients (8.5%) had LHC recurrence after surgery. There were 34 females (60.7%) and 22 males (39.3%). Median duration of recurrence's diagnosis was 24 months (interquartile range: 10-48 months). Recurrence's risk was 2.3% +/- 0.6% at 1 year and 9.1% +/- 1.3% at the 10th year. The history of LHC (hazard ratio, 2; 95% confidential interval, 1.13-3.59) and three cysts or more (hazard ratio, 3.8; 95% confidential interval, 2.07-6.98) was an independent risk factor for recurrence. CONCLUSION We think that the surgeon's practice and experience are the most important to success the surgical treatment. It prevents complications and recurrences.
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Akbulut S, Senol A, Sezgin A, Cakabay B, Dursun M, Satici O. Radical vs conservative surgery for hydatid liver cysts: experience from single center. World J Gastroenterol 2010; 16:953-959. [PMID: 20180233 PMCID: PMC2828599 DOI: 10.3748/wjg.v16.i8.953] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 12/14/2009] [Accepted: 12/21/2009] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the efficacy and safety of radical and conservative surgical interventions for liver hydatid disease. METHODS The study comprised 59 patients in two groups who had undergone radical and conservative surgical procedures for liver hydatid disease in our department between 2004 and 2009. Preoperative diagnostic tools, medical treatments, demographic and clinical characteristics, postoperative follow-up, and recurrence were compared in both groups. RESULTS This non-randomized retrospective study included 59 patients who had undergone liver hydatid disease surgery. The radical technique was used in 18 patients (mean age: 42.1 +/- 13.5 years, seven male, 11 female), and the conservative technique was used in 41 patients (mean age: 43.5 +/- 13.9 years, 17 male, 24 female). The follow-up period ranged from 3 to 58 mo. Although operative time was significantly shorter in the conservative group (P < 0.001), recurrence was significantly reduced in the radical group (P = 0.045). No statistically significant differences were found in terms of hospitalization duration, cyst count and size, location, postoperative complications, scolicidal solution usage, or follow-up duration between the two groups. CONCLUSION The more effective method for preventing postoperative recurrence is radical surgery. Endoscopic retrograde cholangiopancreatography for bile leakage in the early postoperative period may decrease the requirement for repeat surgery.
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Abstract
PURPOSE OF REVIEW Cystic echinococcosis, or cystic hydatidosis, is a complex, chronic disease with a cosmopolitan distribution. In humans, its clinical spectrum ranges from asymptomatic infection to severe, rarely even fatal disease. Four approaches in clinical management exist: surgery, percutaneous techniques and drug treatment for active cysts, and the so-called watch and wait approach for inactive cysts. Allocation of patients to these treatments should be based on cyst stage, size and location, available clinical expertise and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated.We review the currently available evidence for clinical decision-making and discuss ways to improve standards of care of one of the most neglected infectious diseases. RECENT FINDINGS Data are mostly derived from case series and small clinical trials, and treatment guidelines remain at the level of expert opinion. No single high-quality comparative clinical trial of the four treatment options is available to resolve important questions such as stage-specific allocation of treatments, adverse events and long-term relapse rates. Recent work is beginning to acknowledge this problem. SUMMARY Currently, four treatment modalities are available for cystic echinococcosis. The level of evidence on which clinicians have to rely is low. For the time being patients should thus be treated in referral centres. Proper comparative clinical trials are urgently needed.
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Adas G, Karatepe O, Altiok M, Battal M, Bender O, Ozcan D, Karahan S. Diagnostic problems with parasitic and non-parasitic splenic cysts. BMC Surg 2009; 9:9. [PMID: 19476658 PMCID: PMC2701920 DOI: 10.1186/1471-2482-9-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 05/29/2009] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The splenic cysts constitute a very rare clinical entity. They may occur secondary to trauma or even being more seldom due to parasitic infestations, mainly caused by ecchinocccus granulosus. Literature lacks a defined concencus including the treatment plans and follow up strategies, nor long term results of the patients. In the current study, we aimed to evaluate the diagnosis, management of patients with parasitic and non-parasitic splenic cysts together with their long term follow up progresses. METHODS Twenty-four patients with splenic cysts have undergone surgery in our department over the last 9 years. Data from eighteen of the twenty-four patients were collected prospectively, while data from six were retrospectively collected. All patients were assessed in terms of age, gender, hospital stay, preoperative diagnosis, additional disease, serology, ultrasonography, computed tomography (CT), cyst recurrences and treatment. RESULTS In this study, the majority of patients presented with abdominal discomfort and palpable swelling in the left hypochondrium. All patients were operated on electively. The patients included 14 female and 10 male patients, with a mean age of 44.77 years (range 20-62). Splenic hydatid cysts were present in 16 patients, one of whom also had liver hydatid cysts (6.25%). Four other patients were operated on for a simple cyst (16%) two patients for an epithelial cyst, and the last two for splenic lymphangioma. Of the 16 patients diagnosed as having splenic hydatit cysts, 11 (68.7%) were correctly diagnosed. Only two of these patients were administered benzimidazole therapy pre-operatively because of the risk of multicystic disease The mean follow-up period was 64 months (6-108). There were no recurrences of splenic cysts. CONCLUSION Surgeons should keep in mind the possibility of a parasitic cyst when no definitive alternative diagnosis can be made. In the treatment of splenic hydatidosis, benzimidazole therapy is not necessary, although it is crucial to perform splenectomy without rupturing and spilling the cysts.
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Affiliation(s)
- Gokhan Adas
- Okmeydani Training and Research Hospital, Department of General Surgery, Istanbul, Turkey.
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Goksoy E, Saklak M, Saribeyoglu K, Schumpelick V. Chirurgische Therapie bei Echinococcus-Zysten der Leber. Chirurg 2008; 79:729-37. [DOI: 10.1007/s00104-008-1521-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Albendazole is not effective for primary treatment of hepatic hydatid cysts. J Gastrointest Surg 2008; 12:867-71. [PMID: 18085341 DOI: 10.1007/s11605-007-0458-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2007] [Accepted: 11/30/2007] [Indexed: 01/31/2023]
Abstract
INTRODUCTION In current practice, minimal invazive interventions such as percutaneous drainage and laparoscopic surgery in adjunct treatment with benzimidazoles have been gaining acceptance in treatment of hydatid cystic disease with minimal morbidity and mortality. In this prospective study, the efficacy and validity of primary medical therapy in the treatment of hydatid cystic disease has been investigated. PATIENTS AND METHODS Sixty-five patients with hepatic cystic disease were treated with albendazole alone between January 2004 and June 2007. All of the patients were administrated albendazole as 10 mg kg(-1) day(-1) divided into two equal doses for 6 months with ultrasonography (USG), serological tests, full-blood cell count and hepatic function tests performed in 2 months intervals in the course of treatment. RESULTS Fifty of the patients were female and 15 were male with a mean age of 47.0+/-16.9 (17-80). A total number of 106 cysts were present in 65 patients. Mean cystic diameter was 5.5+/-3.6 (1-16). In 41 of the patients, cysts were solitary and in remaining 24 patients cysts were multiple. Mean follow-up period was 28.3+/-8.6 (12-42) months. The overall success rate of albendazole therapy was 18% (12/65) in the study. CONCLUSION Albendazole therapy for hepatic hydatidosis is not effective in the vast majority of patients and, therefore, should not be used as the primary therapy for patients who are surgical candidates.
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Yüksel O, Akyürek N, Sahin T, Salman B, Azili C, Bostanci H. Efficacy of radical surgery in preventing early local recurrence and cavity-related complications in hydatic liver disease. J Gastrointest Surg 2008; 12:483-489. [PMID: 17917786 DOI: 10.1007/s11605-007-0301-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 08/09/2007] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hydatic disease of the liver remains to be a complex worldwide problem especially in rural areas. Early local recurrence and cavity-related complications are still a matter of conflict in the management of hydatic liver disease. The aim of this study is to investigate efficacy of the type of surgical treatment in preventing early local recurrence and cavity-related complications of this disease. Here, we present the preliminary results of our study. METHODS This study was performed prospectively including 32 patients who were operated for hydatic liver disease between January 2001 and January 2005. Patients were randomized into radical and conservative surgery groups. Recurrences at the primary surgical site in the first 2 years were considered as early local recurrence and biliary leakage, biliary fistula, cavity abscess, etc. were considered as cavity-related complications. RESULTS Early local recurrences were observed only after conservative surgical procedures (p=0.045). Recurrent cysts were found to be due to satellite cysts or pericystic disease. Cavity-related complications were seen in six patients in the conservative surgery group (p=0.011). CONCLUSIONS In suitable patients, radical surgical resection provides an effective surgical management option in preventing early local recurrence and cavity-related complications when compared to conservative surgical approaches.
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Affiliation(s)
- Osman Yüksel
- Department of Surgery, Hepato-Pancreato-Biliary Surgery Unit, Gazi University Medical School Beşevler, 06500, Ankara, Turkey.
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Parsak CK, Hanta I, Koltas IS, Sakman G, Akcam T, Kuleci S, Alabaz O. The Effectiveness of Nitric Oxide Derivates in Hydatid Disease. Visc Med 2007. [DOI: 10.1159/000103248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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