Efficiency of two-stage extensive resection interventions in the surgical treatment of patients with disseminated echinococcosis of the liver

Abstract

Introduction. Surgical operations are the main and effective option for treatment of hepatic echinococcosis. The problem of the choice of the type of surgical intervention in the advanced form of hepatic echinococcosis in the conditions of supposed deficiency of the organ functional reserves and development of post-resection hepatic insufficiency remains topical.The aim of the study was to present and analyze the effectiveness of two-stage extensive resection interventions in patients with advanced liver echinococcosis.Materials and methods. The paper presents the results of surgical treatment of 22 patients, 8 male (36.4%) and 14 female (63.6%) operated in the surgical department № 2 of Kuzbass Clinical Emergency Hospital named after M.A. Podgorbunskiy in Kemerovo. The criterion for inclusion in the study was to use of a two-stage extensive resection protocol.Results. The surgical staging methods used in our study to prevent post-resection liver failure showed efficacy in the following parameters: CT volumetry (p < 0.05), residual concentration of indocyanine green at 15 minutes (p < 0.05), statistical predictive model value (p < 0.05) and allowed to prepare patients for resection extensive intervention with a sufficient level of safety. Specific postoperative complications after extensive resection were identified in nine patients (40.1 %) and non-specific complication in three patients (13.6 %). Specific complications are mainly represented by manifestations of PPN manifistations − six cases (66.7 %), including 5 cases (83.3%) with “A” category according to ISGLS, with “B” category − one case (16.7 %). There were no fatalities or relapses in any of the study groups. Discussion When analysing the literature, there is a tendency to search for effective and safe methods of stopping the blood flow of the liver portal system in order to achieve vicarious hypertrophy of the remnant. A common technique for obtaining vicarious hypertrophy of the future liver remnant is radiopaque endosurgical embolization of the portal blood flow. However, there are technical limitations to the availability of the procedure. Laparoscopic clipping of the right portal vein branch is an alternative surgical option.Conclusion. Techniques to achieve vicarious hypertrophy of the liver remnant have proven effective and have prepared patients for extensive liver resections. Two-stage extensive resection interventions for advanced liver echinococcosis are effective and sufficiently safe when performed in specialised hepatology centres.