Standardized endocystectomy technique for surgical treatment of uncomplicated hepatic cystic echinococcosis.

Mohammed Al-Saeedi,Katrin Hoffmann,Oliver Strobel,Tim F Weber,Markus W Büchler,Marija Stojkovic,Omid Ghamarnejad,Thomas Junghanss,Mohammad Golriz,Arianeb Mehrabi,Elias Khajeh,Mar Siles-Lucas

doi:10.1371/journal.pntd.0007516

Mohammed Al-Saeedi, Katrin Hoffmann + Show 10 more

Open Access

https://doi.org/10.1371/journal.pntd.0007516

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Abstract

BackgroundTwo surgical options are available for cystic echinococcosis (CE). The two principal approaches are radical (resection of the cyst) and conservative (evacuation of the cyst content and partial removal of the cyst capsule). Here, we describe a standardized endocystectomy technique for hepatic echinococcosis.Subjects and methodsTwenty-one patients (male/female: 4/3; median age: 28 years) with uncomplicated, isolated hepatic CE (cyst stages WHO CE1, 2, 3a, and 3b) that were treated with the standardized endocystectomy described in this paper. Before the operation and during the follow-up period (mean: 33.8 months, median: 24 months), patients underwent clinical and sonographical and/or magnetic resonance imaging assessment during regular visits managed by an interdisciplinary team.ResultsForty-seven cysts were treated with the standardized endocystectomy technique. The median number of cysts per patient was two (range: 1–8). Nine patients (43%) had a single cystic lesion. The median operation time was 165 minutes and the median intraoperative bleeding volume was 200 mL. The median hospital stay was nine days (range: 6–28 days). Morbidity (Clavien-Dindo III) occurred in four patients (19%). No mortality and no recurrence were found during the median follow-up time of 24 months.ConclusionsThe standardized endocystectomy technique presented is a safe procedure with acceptable morbidity, no mortality, and without recurrences in our patient series. Important components of our CE management are interdisciplinary patient care, adequate diagnostic work-ups, and regular pre- and postoperative visits, including long-term follow-up for early and reliable capture of recurrences.

Highlights

The standardized endocystectomy technique presented is a safe procedure with acceptable morbidity, no mortality, and without recurrences in our patient series
Cystic echinococcosis (CE) is a parasitic disease caused by ingestion of the larval stage of Echinococcus granulosus
We presented a conservative surgical approach, a standardized endocystectomy technique, that is suitable for surgical residents

Summary

Introduction

Cystic echinococcosis (CE) is a parasitic disease caused by ingestion of the larval stage of Echinococcus granulosus. In most high-income countries, the incidence of CE is very low, diagnosed mainly in migrants originating from endemic regions. CE is largely asymptomatic, diagnosed incidentally or when complications precipitate, such as biliary obstruction due to cysto-biliary fistulas, spillage of cyst content into the biliary tree, and compression of vessels (bile ducts, portal or hepatic veins, and inferior caval vein in hepatic CE). Medical treatment (benzimidazoles), percutaneous interventions, surgery, and the watchand-wait strategy are the available treatment options and the treatment strategy is decided based on the WHO CE cyst classification [1, 3,4,5,6,7,8,9,10,11]. Two surgical options are available for cystic echinococcosis (CE). We describe a standardized endocystectomy technique for hepatic echinococcosis

Methods

Discussion

Conclusion