A novel laparoscopic technique for drainage of hydatid cyst in posterior segment of liver

Anil Kumar T,Manash Ranjan Sahoo,Manoj Gowda

doi:10.5348/ijcri-2013-04-293-cs-2

Abstract

Although several surgeries have proven to be effective for hydatid cyst of liver, but laparoscopic surgery has its own stand. We report here a novel laparoscopic technique for drainage of hydatid cyst in posterior segment of liver in a series of four patients who had two hydatid cysts in same lobe of the liver.Four patients who presented with right upper abdominal pain was investigated with ultrasound and computed tomography scan which revealed two hydatid cyst in same right lobe of liver with one of the cyst in posterior segment. On the operating table laparoscopically first cyst was drained with Palanivelu’s hydatid system and irrigated with chlorexidine solution. Through this first cyst second cyst in the posterior segment was punctured, drained and irrigated. Postoperative period was uneventful. This novel technique of approaching second cyst through first cyst is safe, feasible, very effective for cysts in the posterior segments and yield good results and can also approach a third cyst, if it is near to the first cyst. If there are three or more cysts, we can reduce multiple deroofing by approaching the other nearer cysts through already deroofed cyst.

Highlights

Several surgeries have proven to be effective for hydatid cyst of liver, but laparoscopic surgery has its own stand
Hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus or Ech
We report here a novel laparoscopic technique for drainage of hydatid cyst in posterior segment of liver in a series of four patients who had two hydatid cysts in same lobe of the liver by approaching second cyst in the posterior segment through the first cyst

Summary

INTRODUCTION

Hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus or Ech. The conventional operative procedures of the hydatid cyst of the liver are enucleation, cystectomy, evacuation, marsupilisation, etc. It involves a significant morbidity especially in term of wound infection. Telescope was introduced to visualize the interior of cyst, if any redundant material left, it was irrigated and aspirated, deroofing of the cyst was done after removal of ectocyst membrane (Figure 3) and looked for any biliary leakage which was found in two of our cases which was ligated with figure of eight with 20 vicryl intracorporeally that prevented further leakage. Ectocyst membrane of the posterior hydatid cyst was removed through the first cyst (Figure 4) Interior of both first and second cyst was visualized with telescope for redundant daughter cyst and bile leakage. Patients had very good recovery and it was uneventful

Findings

DISCUSSION

CONCLUSION