Management Of Hepatic Hydatid Cysts Research Articles

Cystic Echinococcosis of the Liver: Correlation Between Intra-Operative Ultrasound and Pre-Operative Imaging.

Background: Imaging plays an essential role in the management of hepatic hydatid cysts (HCE). The objective of our study was to determine the correlation between pre-operative ultrasound, computed tomography (CT), and intra-operative ultrasound (IOUS) in studying the characteristics and complications of HCE. Patients and Methods: This was a prospective, descriptive, and analytical study conducted in the General Surgery Department of Habib Bourguiba Hospital in Sfax. The study included patients with HCE who underwent conservative surgery between April 2017 and June 2022. Results: We enrolled 49 patients with 94 cysts. At the end of our study, IOUS allowed for better detection of HCE (98.8%) regardless of the number of cysts per patient. IOUS and CT were accurate in studying the location of cysts (κ = 1), whereas pre-operative abdominal ultrasound was less efficient (κ = 0.870). IOUS was the best examination for detecting exocysts (κ = 0.961), studying daughter cysts (κ = 0.823), and exploring vascular relations, but it was less effective (κ = 0.523) in detecting calcifications. Regarding classifications, ultrasound and CT had similar results. However, IOUS was most reliable in differentiating between CE3b and CE4 types (κ = 0.653). Ultrasound, CT, and IOUS were not sensitive in detecting latent HCE suppurations and cystobiliary fistulas. Conclusions: Performing IOUS is essential to prevent recurrences and reduce post-operative morbidity.

Laparoscopic Management of Benign Cystic Lesions of the Liver

Background: Benign cystic lesions of the liver are rare conditions. Owing to the improvement in investigation modalities like ultrasound and CT scan these lesions are found frequently today. A safe and effective method of laparoscopic management for hepatic hydatid cysts, simple liver cysts and liver abscess is described along with a review of the relevant literature. Objectives: To report our experience in laparoscopic management of hepatic hydatid cysts, simple liver cysts and liver abscess with the outcome, feasibility and complications of the procedure. Methods: This was a prospective observational study held at BSMMU, BIRDEM, DMCH, ShMCH and some private hospital in Dhaka city from July 2014 to December 2014. Total sample size was thirty cases. All patients diagnosed on ultrasound and CT scan and who have ful-filed the inclusion and exclusions criteria were included in the study. Laparoscopic unroofing, evacuation inocleation and aspiration were done. Operative procedure, operation time, conversion to laparotomy, complications, and mortality and recurrence rates were analysed. Results: There were three groups of benign cystic lesions: hepatic hydatid cysts (n=18), simple liver cysts (n=8) and liver abscess (n=4). Mean age of the patients were 43.6 years with hydatid cysts, 46.7 years with simple liver cysts, and 59.6 years in patients with liver abscess. Minimum age was 17 years and maximum age was 69 years. Male patients were 10 in hydatid cysts group, 3 in simple liver cysts group and 3 in liver abscess group. Most of the patients presented with pain, 72.22% in hydatid cysts, 62.5% in simple liver cysts and 100% in liver abscess. Most of the lesions were single and they were located in the right lobe of the liver in majority of cases. Benign cystic lesions were successfully treated laparoscopcally in 29 cases. Open surgery conversion was needed in one case 3.33%, with hepatic hydatid cysts. Complications included port site infection in 2 (6.67%), one in .....

Laparoscopic management of hepatic hydatid cyst: case report

Hydatid disease, being endemic in several areas of the world, is of interest even to surgeons in non-endemic areas because they may encounter the disease due to ease and rapidity of travel as well as immigration. Surgery remains the method of choice in the management of hepatic hydatid cysts. Because of limited experience, controversies still exist about the laparoscopic managememt of hepatic hydatid cysts. We report a case of a thirty four years-old male, presented with a well defined large cyst occupying most of the right hepatic lobe successfully treated with laparoscopic total cystectomy. The operation and hospitalization period were uncomplicated. Controlled follow-up clinically and radiologically showed no remaining pathology or recurrence in any form.

Laparoscopic Management of Hepatic Hydatid Cyst at Bangabandhu Sheikh Mujib Medical University

Background: Laparoscopic management of hydatid cyst in the liver is now becoming popular with the introduction of modern devices like Pallanivelue Hydatid Cyst Cannula System that makes the procedure easier, safe, and acceptable. The laparoscopic approach is not only a cosmetic issue; it also prevents the recurrence rate by preventing spillage and complete removal of endocyst. Objective: Here we assess the Laparoscopic management of hydatid cyst in the liver of 30 cases at the Department of General Surgery. Methods: It is a prospective study having ages ranging from 18 to 65 years were included in this study, from April 2015 to March 2020. Laparoscopic endocystectomy was performed in all cases with deroofing of the cyst wall and observed the outcome of the procedure. All the cases were diagnosed clinically and confirmed by ultrasonography and CT scan. Results: A total of 30 patients, 13 males, and 17 were females. The most common presenting complaints were pain in the abdomen in 20(66.66 %), a lump in the right upper abdomen in 18(60 %), jaundice 2(10 %). Hepatic Hydatid cyst diagnosed by USG, CT scan, and serological test were included in this study. The distribution of cyst sizes was: 1-5 cm 3; 6-10 cm 8; 11-15 cm 10; > 15 cm 9 patients. Abdominal ultrasound and CT scan were done to confirm the diagnosis of hepatic hydatid cyst in all patients. The right lobe was involved in 25(83.33 %), left lobe in 4(13.33 %) with both lobes in 1(3.33 %). Intraoperative complications 5(16.66%). Per operative bleeding 1(3.33%), spillage 2(6.66%), and cystic biliary communication 2(6.66%). The main operating time was 95(60-120) minutes. The mean duration of hospital stay was 5.22(3-10) days. Conclusion: The laparoscopic cyst evacuation and omentoplasty using PHS are safe for treating the hydatid cyst of the liver in the selected patients, while addressing all the conventional surgical principles of treating the hydatid cysts, like aspiration, prevention of spillage, sterilization of cysts, and partial deroofing. It aids early recovery with good cosmetic results. PHS is an ideal method for single or multiple hydatid cysts of the liver with minimal complications and morbidity.

Radical Surgical Procedure in Management of Hepatic Hydatid Cysts. 10 Years Centre Experience.

Radical Surgical Procedure in Management of Hepatic Hydatid Cysts. 10 Years Centre Experience.

Management of residual cavity of liver hydatid cysts after partial cystectomy: which procedure for which patient?

Background Hydatidosis caused by Echinococcus granulosus remains an important and challenging medical problem. The most common location of the hydatid cysts is the liver. In this study, we present the experience in the management of hepatic hydatid cyst residual cavities, and we designed a management algorithm depending on the size and location of the cyst. Patients and methods This study was conducted in Cairo University Hospital, Egypt, and Al-Thawrah and Al-Kuwait Teaching Hospitals, Sana’a, Yemen, between March 2006 and February 2017. Only patients with single hydatid cyst in the liver were included in this study. Results All patients had endocystectomy and then were managed according to the size of the cyst as the proposed algorithm. Complicated cysts required external drainage, whereas uncomplicated cysts were classified into three groups according to their size ( 15 cm). Conclusion The surgical strategy for managing hepatic hydatid cysts is not yet standardized. The surgical procedure selected must be made according to the complications of the cyst and its size.

Clinical Presentations and Surgical Management of Hepatic Hydatid Cyst: Ten Years’ Experience in Three Teaching Hospitals in Egypt and Yemen

Clinical Presentations and Surgical Management of Hepatic Hydatid Cyst: Ten Years’ Experience in Three Teaching Hospitals in Egypt and Yemen

Surgical management of hepatic hydatid cysts – conservative versus radical surgery

BackgroundSurgical 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. MethodsThis 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. ResultsSixty-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. ConclusionRadical surgery reduces post-operative bile leak and prevents recurrence and may be preferable to conservative surgery.

Novel Interventional Management of Hepatic Hydatid Cyst with Nanosecond Pulses on Experimental Mouse Model

The nanosecond pulsed electric field (nsPEF) is investigated as an alternative plan for benign hepatic hydatid cyst. Altogether 72 C57B6 mice were included. Normal group (n = 12) had no parasite injection and the other 60 mice were used to induce hydatid cyst in liver by injecting protoscolices in portal vein. The liver hydatid cysts were exposed to nsPEF with different doses and then follow up. The standard surgery was performed as positive control. The hydatid cyst growth was monitored by ultrasound; the morphology was checked by gross anatomy and pathology was tested by H&E stain. In nsPEF-treated groups no hepatic failure nor bleeding were observed. As a comparison, in the surgery group, high post-treatment complications occurred (50%). Significant parasite growth inhibition was seen in high nsPEF dose group as compared with control group (P < 0.05). Pathological analysis confirmed destruction of hydatid cyst with sharp demarcation defined by the electrodes. Laboratory analysis showed nsPEF stimulated a time-dependent infection and recoverable liver function. The traumatic reactions defined by white blood count was significant lower than surgery groups (P < 0.05).Preliminary studies demonstrate nsPEF ablation can be applied on hepatic hydatid by inhibiting parasite growth, destructing the cyst and stimulating infections.

Surgical management of hepatic hydatid cyst in children

The aim of this study was to demonstrate the surgical treatment and outcome of hydatid cyst in liver in children. The age of presentation varied from 8-11 years. All patients had abdominal pain, five had lump in right hypochondrium and three patients had fever. Hydatid cyst serology, indirect hemaglutination test, ultrasonography and CT scan done in all the patients. Histological examination supported the diagnosis of hydatidosis since the cyst wall contains outer laminated and inner germinal layer. All the patients got relief of their preoperative symptoms after surgery. Two patients had positive serology after surgery. Therefore, they were given two additional regimen of albendazole and turned out to be serologically negative. In conclusion, hydatid cyst management in children is not consensual. However, conservative surgery remains the treatment of choice to avoid serious complication in the endemic region of Indian subcontinent.

Laparoscopic management of parasitic liver cysts: A retrospective, comparative study

Introduction: Parasitic liver cysts are common in many areas of the world. In our country, hydatid disease is the commonest to cause cystic lesions. We reviewed our data to compare and analyze the outcome of laparoscopic management of these patients. This paper assesses the feasibility and safety of laparoscopic management of hepatic hydatid disease in a tertiary center in Egypt. Materials and Methods: We retrospectively reviewed our operative and inpatient data at the National liver institute, Menoufia university, Egypt for clinical and operative, postoperative details patients with preoperative diagnoses of a hepatic hydatid disease starting from June 2012 to June 2015. Results: 47 patients had operative management for hepatic hydatid cystic lesions. Twenty seven patients had laparoscopic management and 20 patients were managed through open procedures. Operative procedure included endocystectomy in all laparoscopic cases and while three of the open group had liver resection in addition. Hospital stay was at a mean of 3 days for lap cases and 6 cases for open group. Complications included one cases of bile leak and minor wound infections in the open group. While there were no complications in in the lap group. Follow up showed occurrence of recurrence in two of the open group only. Conclusions: With conventional laparoscopic instruments, the laparoscopic approach in the management of hepatic hydatid cysts is safe and feasible even. It showed shorter operative time and hospital stay with relatively decreased postoperative complication rate.

Laparoscopic management of hepatic hydatid cyst in children: Our early experiences

Laparoscopic management of hepatic hydatid cyst in children: Our early experiences

External Tube Drainage Versus no Drainage in Hepatic Hydatid Cysts with Cystobiliary Communications

Echinococcosis (hydatid disease) is a zoonosis caused by the larval stage of Echinococcus granulosus. About seventy-five per cent of all hydatid cysts are found in the liver. Surgical management of hepatic hydatid cyst includes neutralization of the parasite, evacuation of cyst, removal of germinal lining and management of the residual cavity. Our study focussed on the management of the residual cavity in patients with cystobiliary communications. We divided the patients into two groups of 40 patients each. In both the groups the cystobiliary communications were ligated using sutures. After closing the cystobiliary communications, the residual cavity was left to drain externally using a polyvinyl chloride tube in group 1 whereas either capitonnage or omentoplasty was done in group 2. The results were studied in terms of the postoperative complications, mortality and hospital stay. In the patients managed by external tube drainage, average hospital stay was 6.95 ± 0.93 days while as patients in group 2 had an average post operative stay of 4.54 ± 0.76 days (p value = 0.0001). Bile leak was seen in 6 (15%) patients in group 1, while as only 1(2.5%) patient from group 2 developed an intra-abdominal bile collection. Wound infection and deep vein thrombosis was seen in one patient each in group 1, whereas no such complication was seen in group 2. One (2.5%) patient from each group had a recurrence of the disease during follow-up.

Endoscopic management of hepatic hydatid cyst with biliary communication

A serious complication of hepatic hydatid cyst disease is communication between the cyst and the biliary tree. Surgical management of biliary fistulas is associated with high morbidity and mortality. We carried out a prospective study of endoscopic management of hydatid cysts communicating with bile ducts in 28 patients. Presence of biliary fistula was suspected by jaundice and/or persistent external biliary fistula after surgical excision and was confirmed by endoscopic retrograde cholangiopancreatography (ERCP). Patients underwent endoscopic sphincterotomy, and either biliary stenting or nasobiliary drainage. Nasobiliary drains were removed when bile leakage stopped and closure of the fistula was confirmed by cholangiography; stents were removed after 4-6 weeks. Of 120 patients with hepatic hydatid cyst seen over a 10-year period, 28 patients developed fistula between the hepatic hydatid cyst and intrahepatic bile ducts (right intrahepatic bile ducts in 20 patients, left intrahepatic bile ducts in eight patients). Nine of 28 patients had persistent external biliary fistula after surgery. Ten patients showed membranes in bile ducts on cholangiography. We carried out either sphincterotomy with insertion of a nasobiliary drain (n=6) or sphincterotomy with biliary stenting (n=22). In 10 patients, the membranes were removed from bile ducts during ERCP. Fistulas healed in all patients after a median time of 11 days (range 5-45 days) after endoscopic treatment. We were able to remove nasobiliary drainage catheters and stents 8-45 days after placement. Endoscopic therapy is an effective mode of treatment for biliary fistulas complicating hepatic hydatid cyst.

Single hydatid cyst of liver managed with laparoscopy - a case study.

Hydatid disease is not common in human populations of highly developed urban areas. However, increasing immigration, travel and international tourism have led to a recent increase in incidence. Surgery remains the method of choice in the management of hepatic hydatid cysts. Laparoscopic treatment of the disease has been questionable so far, though it is feasible and safe in use. We report a case of an 18-year-old woman, successfully treated with total cystectomy located in a favourable laparoscopic area – the border of the 3rd and 4th segment of the hepatic left lobe. The operation and hospitalization period were uncomplicated. Controlled follow-up laboratory and radiological tests showed no remaining pathology or recurrence in any form. In conclusion we state that the laparoscopic technique provides a feasible and efficacious option of treatment for some types of hydatid cysts located in the liver. It is a safe miniinvasive surgical approach which enables postoperative discomfort to be reduced and results in a quick recovery.

YEndoscopic-Assisted Laparoscopic Management of Hepatic Hydatid Cyst

Background : Because of limited experience, controversies still exist about the laparoscopic management of hepatic hydatid cysts. In this study, we are presenting our early experience with this new technique of endoscopic-assisted laparoscopic management of hepatic hydatid cyst compared with open surgery. Patients and Methods: Between January 2000 and July 2010 fifteen patients (12 males and 3 females) with hepatic hydatid cysts were referred from gastro-entrology unit at National Hepatology and Tropical Medicine Research Institute. All patients had a single, large hepatic hydatid cyst. Patients received a preoperative course of Albendazole for one month. Six patients underwent open surgery and nine patients underwent EAL technique. All patients in the EAL group had pre-operative ERCP to rule out any biliary communication. Operative time, hospital stay, post-operative complications and follow-up were recorded. Results: Mean operative time was 206 minutes in the open surgery group compared with 110 minutes in EAL group. The mean hospital stay was 22.3days in open group and 8days in EAL group. All patients required insertion of intra-abdominal drain. At a maximum follow-up of 9 years, only two patients developed post-operative bile leak in the open group and treated conservatively. Conclusion: We concluded that endoscopic-assisted laparoscopic technique is a safe, simple and promising methods with a potentially low risk of intra-abdominal spillage compared with open surgery.

A new instrument, the "Perfore-Aspirator" for laparoscopic treatment of hydatid cysts of the liver.

The authors introduce a new instrument functioning as both perforator and aspirator in the laparoscopic management of hepatic hydatid cysts. Between January 1998 and January 2002, 11 laparoscopic cystotomy + partial cystectomy + drainage procedures were performed for eight consecutive patients. Eight of the cysts were located in the right lobe, and the remaining three in the left. The average diameter (+/-SD) of the cysts was 9.6 +/- 3.66 cm, and the mean age of the patients was 31.3 +/- 7.24 years. The diagnosis was confirmed by ultrasonography and/or computerized tomography. The procedure was performed with the help of three ports. The "perfore-aspirator" instrument (Bahadir Tibbi Aletler A. S., Samsun, Turkey) was introduced through the 10-mm trocar at the subcostal area, and the cystotomy procedure was done with success. Then, a partial cystectomy procedure was performed with the use of a grasper and scissors attached to an electrocautery device. The average hospitalization period was 5 +/- 1.69 days. No major morbidity or mortality was seen. All patients were treated with albendazole preoperatively and postoperatively.

Percutaneous treatment of hepatic hydatid cysts: an alternative to surgery.

Percutaneous treatment of hydatid cysts is relatively new, and the data related to it are limited. The purpose of this study was to provide additional data to strengthen the proof of its effectiveness. One hundred sixty-eight hepatic cysts in 111 patients were treated using a percutaneous approach under sonographic and fluoroscopic guidance. Cysts smaller than 5 cm in diameter were treated with a one-stage procedure that consisted of puncture of the cyst, aspiration of fluid, and injection and reaspiration of hypertonic saline solution. Larger cysts were treated with a two-stage procedure that consisted of the one-stage procedure followed by catheterization and sclerotherapy with alcohol. The mean observation time was 19 months (range, 1-48 months). Follow-up examinations showed progressive shrinkage and solidification of the cysts. Early complications occurred in 32 (28.8%) of the 111 patients, including fatal anaphylaxis in one patient, biliary fistula in seven, infection of the cyst in four, persistent serous drainage from the cyst in two, intraperitoneal leakage of cyst fluid in two, urticaria in seven, fever without evidence of infection in seven, and pleural effusion in two. Late complications occurred in four (3.8%) of the 104 patients who underwent follow-up examinations, including local recurrence in three patients and intrabiliary rupture of a cyst in one patient. Our experience indicates that percutaneous treatment is efficient in the management of hepatic hydatid cysts and that this technique should be considered an alternative to surgery.