Management Of Liver Hydatid Cyst Research Articles

Management of Liver Hydatid Cysts: A Retrospective Analysis of 293 Surgical Cases from Southern Iran.

The current study aimed to evaluate the therapeutic features and complications of liver hydatid cyst in patients who underwent surgery for cystic echinococcosis (CE) in Fars province, southern Iran. A total of 293 patients who underwent surgery for liver hydatid cyst from 2004 to 2018 in Fars province, southern Iran, were retrospectively evaluated. The clinical records of patients were reviewed, and the demographic and clinical characteristics of each patient were assessed. Of the total of 293 cases, 178 (60.9%) were females and 115 (39.1%) were males. The mean age of the subjects was 37.22 (±20.55) years. The mean size of the liver hydatid cyst was 9.18 (±4.365) cm. Of the 293 patients studied, 227 (77.4%) had hydatid cysts only in the liver, while 55 (9.4%) had both liver and lung cysts. More than half of the liver cysts (65.9%) were located in the right portion of the liver (segment 5 to 8). Of the 293 cases, 52 (17.7%) underwent radical surgery, while 241 (82.3%) underwent conservative surgery. Recurrence of hydatid cyst was recorded in 46 (15%) of cases. Patients who were treated with radical surgery in comparison with those who had conservative surgery had a lower recurrence rate but a longer duration of hospital stay (P < 0.05). Recurrence remains as one of the major challenges in the management of hydatid cyst. Radical surgery reduces the chance of recurrence, although this procedure increases the length of hospital stay.

Comparative study of laparoscopic versus open surgery in cases of liver hydatid cysts

Background: Hydatidosis is a zoonotic infection, and treatment is mandatory to avoid complications. The infection can be asymptomatic or severe, causing extensive organ damage and even death of the patient. Aims and Objectives: The main aim of this study is to find out the merits and demerits of laparoscopy over that of open surgery in the treatment of hydatid cysts of liver. Materials and Methods: This prospective observational study was done on 50 patients who had liver hydatid disease admitted in the Department of Surgery, Shyam Shah Medical College Rewa (M.P.). Patients were divided into two groups consisting of 25 cases in each. Group A: managed by laparoscopic surgery and Group B: managed by open surgery. Results: The mean operative time in Group A was 99.6 min, while in Group B, it was 140.4 min. Group A patients were mobilized early and resumed duty very fast then Group B. The mean duration of stay in hospital was 8.64 days (range: 4–20 days) in Group A and 11.84 days (range: 4–12 days) in Group B. Wound infection seen in 9 patients in Group B and 0% in Group A. General complication rate was 32% in Group B and 8% in Group A. No recurrence noticed in either group during follow-up. Conclusion: Overall laparoscopic management of liver hydatid cyst is cost-effective in terms of early mobilization, early discharge, and early resumption of work along with cosmetic benefit.

Forty-five patients with hydatid liver cysts: Preoperative eosinophil and postoperative liver enzyme elevations after cystectomy and resection

Aim: Although the individualized and multidisciplinary treatment approach is important in the management of liver hydatid cyst, treatment modalities include medical, interventional or minimally invasive, and surgical. Our aim of the study was to investigate the efficacy of eosinophil number and percentage as an inexpensive and practical method that may be useful in the prediction of preoperative recurrence in patients who have undergone surgery for hydatid cysts. Material and Methods: Patients who underwent surgery for hydatid cyst of the liver at our University Medical Faculty Hospital in the last 8 years were retrospectively reviewed. Age, sex, history of animal contact, cyst size, ELISA tests, preoperative neutrophils, preoperative eosinophils, preoperative albendazole use, postoperative albendazole use, postoperative AST, postoperative ALT, postoperative INR, complications, and recurrences were analyzed. Results: A total of 45 patients with complete data sets were included. The mean preoperative neutrophil and eosinophil percentages were 60.20% (30%-96%) and 4.57% (1%-41%), respectively. Postoperative complications were seen in 2 patients (4.4%); these complications were collections in the operating lung and cystobiliary fistula. The mean postoperative AST, ALT, INR were 139.13 (12-636), 155.31 (7-569), 1.06 (0.9-2.6), respectively. The mean hospital stay was 13.4 days (2-90). The mean duration of albendazole use in the postoperative period was 3.66 months (1-24 months). Recurrence was observed in 9 cases (20%) during the follow-up period. Conclusion: Although hydatid cysts and eosinophilia are reported in literature, association of eosinophilia with recurrence, size and prognosis is not reported. Our study showed that preoperative eosinophils and eosinophil/neutrophil ratio are inexpensive, easily accessible and effective in predicting recurrence. We believe that the validity of the tests will increase as eosinophil percentage and eosinophil/neutrophil percentage (ENPR), for which cut-off values have been established, become more widely used and tested in prospective controlled studies with larger groups.

Radical versus conservative surgical treatment of liver hydatid cysts: A paired comparison analysis

BackgroundThe 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. MethodsData 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. ResultsA 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. ConclusionRS 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.

A review of the diagnosis and management of liver hydatid cyst.

Hydatidosis is a zoonosis caused by Echinococcus in the larval stage. Humans are accidental intermediary hosts where cystic lesions develop, primarily in the liver and the lungs. It is usually asymptomatic, hence it often represents an incidental finding. Symptoms result from cyst expansion and/or host inflammatory reaction. Hepatomegaly is the most common sign. Hydatidosis induces no specific changes in lab tests but immunodiagnostics are available that may complement its study, with antibody detection being the modality of choice. While ultrasound is the main diagnostic technique, tomography offers more accurate information regarding both characteristics and anatomical relations. A number of therapy options are presently available. Treatment with albendazole, whether combined or not with praziquantel, is useful for smaller, uncomplicated cysts (< 5 cm). Only 30 % of cysts disappear with medical treatment alone. Surgery is indicated for bigger liver cysts (> 10 cm), and cysts at risk of rupture and/or complicated cysts. The laparoscopic approach is scarcely widespread. The radical technique (total cystopericystectomy) is preferable because of its lower risk for postoperative abdominal infection, biliary fistula, and overall morbidity. Conservative techniques are appropriate in endemic areas where surgery is performed by nonspecialist surgeons. PAIR (puncture-aspiration-injection-reaspiration) is an innovative technique representing an alternative to surgery. It is indicated for inoperable cases and/or patients who reject surgery, for recurrence after surgery, and for lack of response to medical treatment. Active surveillance without treatment may be indicated for quiescent or inactive, uncomplicated liver cysts.

A comparative analysis of radical and non-radical surgical treatment of hydatid liver echinococcosis: a single-center analysis

The aim of this study was to compare the postoperative outcome and long-term results after management of liver hydatid cyst by radical and non-radical surgeries. From January 2015 to December 2017, 86 patients were treated with various surgical interventions for liver hydatid cyst. These patients were retrospectively divided into two groups according to the surgical method for treatment: radical methods (e.g., liver resection and pericystectomy) and non-radical methods (e.g., echinococcectomy). Of the 86 patients, 50 (58%) underwent radical treatment and 36 (42%) underwent non-radical treatment. Clinical data and outcomes were retrospectively analyzed. Eighty (93%) patients were considered to have been completely cured of their hydatid disease. Surgery duration in the non-radical treatment group was significantly shorter than in the radical treatment group (p < 0.01). There were no cases of biliary leakage in the liver resection patients during the postoperative period. In contrast, among the echinococcectomy patients, biliary leakage occurred in 6 (16.7%), which was significantly higher than with other modalities (p < 0.05). Recurrence occurred at a median of 32 months after surgery. Recurrent liver hydatid disease occurred in 6 cases (7%): radical group, 1 (2%); non-radical group, 5 (13.9%). There were no mortalities in either group in the postoperative period. Postoperative hospital stay was significantly shorter in the liver resection patients than in the other patients (p < 0.01). Radical surgical treatment of liver hydatid cyst is more effective than non-radical surgery, resulting in a reduced recurrence rate, reduced postoperative complication rate, and early recovery of patients.

Comparative study of laparoscopic and open surgery in management of 50 cases of liver hydatid cyst

Background: Echinococcosis is caused by parasite called Echinococcus granulosus and Echinococcus multilocularis. The modern treatment of hydatid cyst of the liver varies from surgical intervention to percutaneous drainage or medical therapy.Methods: This clinical study was done on 50 patients who had liver hydatid disease admitted in Sir T Hospital, Bhavnagar from August 2013 to February 2016. Patients were divided into two groups consisting of 25 cases in each. Group A: managed by open surgery. Group B: managed by laparoscopic surgery. All patients followed up for 6 months after surgery.Results: The mean operative time in Group A was 65.2 minutes (range 35-100 minutes) while in Group B it was 76.32 minutes (range 50-100 minutes). Group B patients were mobilised early and resumed duty very fast then Group A. The mean duration of stay in hospital was 12.4 days (range 4-20 days) in Group A and 6.2 days (range 4-12 days) in Group B. Wound infection seen in 16% in Group A and 0% in Group B. General complication rate was 32% in Group A and 8% in Group B. No recurrence noticed in either group during follow up.Conclusions: Overall laparoscopic management of liver hydatid cyst is cost effective in terms of early mobilization, early discharge and early resumption of work along with cosmetic benefit.

Hydatid Cyst Liver, Laproscopic Management-Our Experience with 37 Patients

Hydatid disease is caused by Echinococcus Granulosus and is a chronic parasitic disease in humans. The commonest organ involved in human beings is liver (50-80%) followed by lungs (15-47%). The surgical management of liver hydatid in humans has changed with the technological advances and modifications in laparoscopy from simple drainage to more advanced procedures like pericystectomy, segmentectomy and even hepatectomy in some cases. We conducted this study to assess the safety and outcomes of laparoscopic management of liver hydatid cysts in 37 patients and concluded that the Laparoscopic management of liver hydatid cyst is safe and effective in selected patients with a low recurrence rate and an acceptable biliary leak rate which can be managed with ERCP.

Outcomes of radical surgical management in liver hydatid cysts: 7 years center experience

Aim: To evaluate our experience of radical treatment in management of liver hydatid cyst. As liver is considered the organ most frequently infected with hydatid disease.

Management of liver hydatid cyst with cystobiliary communication and acute cholangitis: a 27-year experience.

The rupture of the hydatid cyst into the bile ducts is a common and serious complication. The rupture can be latent or revealed after a complication such as acute cholangitis. The objective of this study was to discuss the clinical features, radiographic findings, and surgical treatment of this rare complication. A retrospective analysis of patients operated for acute cholangitis caused by hydatid cyst between January 1990 and May 2016 was conducted. Our study included 55 cases of acute cholangitis caused by ruptured hydatid cyst: 35 were men and 20 were women. Five patients had medical history of hydatid cyst. On imaging, all patients had a dilated bile duct. In 51 cases, there was a single hydatid cyst. Hydatid cysts with fistula were located in the right lobe of the liver in 49 cases and in the left lobe in 6 cases. Seven patients underwent an emergency surgery after admission, while others were operated after 3-8days. A conservative procedure associated with drainage was applied in 49 cases. Endoscopic treatment was performed in four cases which failed in two cases. Twenty-eight cases developed postoperative complications, among which the most common complication was biliary fistula (n - 17). There were eight cases of postoperative deaths (14.5%). Liver hydatid cyst with cystobiliary communication and superadded acute cholangitis is a serious clinical problem requiring the early diagnosis and surgery in the absence of endoscopic therapy.

Laparoscopic Approach for Management of Hydatid Cyst of Liver.

Laparoscopy surgery trials are small and unconvincing at present and are limited to higher centers. The objective of the study is to determine the clinical features, prevalence of site of hydatid cyst and complications of this modality of this treatment. A cross sectional study was carried out in all patients with one or two hepatic hydatid cyst who underwent laparoscopic management in KMCTH from January 2013 to March 2015 were included in the study. Aspiration, deroofing and evacuation of the hydatid cyst were done. Twenty six patients underwent laparoscopic management for liver hydatid cysts. Males were seven (65.38%) and females were 9(34.61%).The mean age was 35.5±13.1 years (range 21-55years.) The commonest complaint was pain and discomfort in 13(50%) patients and lump in 6(13.06%) patients. Twenty four (92.3%) patients were successfully treated with laparoscopic approach. Two (7.69%) patients had to be converted to laparotomy because of dense adhesions and bleeding. Mean operation time was 43.6±10.6 minutes. Two (7.69%) patients had port site infection. One (3.84%) patient had bile leak and no recurrence and mortality in our series. Laparoscopic management of liver hydatid cyst was safe and effective in selective group of patients in equipped hospital.

Retraction notice to “Management of liver hydatid cysts – Current perspectives” [Medical Journal Armed forces India 68 (2012) 304–309

[This retracts the article DOI: 10.1016/j.mjafi.2012.04.010.].

Long-Term Results of Percutaneous Management of Liver Hydatid Cysts: - Experience of a University Hospital in Endemic Region

Background and objective: Surgery was considered for years the standard treatment for all stages of liver hydatid cysts (LHC). Percutaneous treatment has becomes a fast, reliable and more efficient method in selected cases. The purpose of this study is to evaluate the effectiveness of percutaneous treatment of LHC on the basis of our department long-term results. Patients and Methods: This study includes all patients who benefited from percutaneous treatment for LHC from December 1998 to April 2012. Puncture aspiration, injection, and re-aspiration (PAIR) were used for hydatid cysts smaller than 6 cm. Larger cysts, infected cysts and those with biliary fistula were treated by puncture associated to drainage (PA-PD). Absolute alcohol was used as sclerosing agent. Reduction of the size of the cyst more than 50%, pseudo-tumour echo pattern and disappearance of the cyst at the follow-up were retained as criteria of treatment efficacy. Results: Two hundred thirty patients (136 female and 94 male; mean age: 35 years old) with 278 LHC underwent percutaneous treatment. Mean initial cyst diameter was 76.8 mm [20-180 mm]. According to Gharbi's classification, types I and II LHC accounted for 74% and 25% respectively. Fourteen patients (6%) presented with an infected cavity and 27 patients (12%) had a biliary fistula at diagnosis (12%). PA-PD was initially performedin 23 patients. No mortality, abdominal dissemination, or tract seeding occurred. Minor complications like urticaria, cutaneous rash and fever were reported in 24 patients (10%). One case of anaphylactic shock was reported with good evolution. Mean hospitalization time was 3 days ± 1.5 for uncomplicated cases and 16.5 days± 4.2 for complicated cases. 229 out of 230 patients were cured, whereas one recurrence has been reported. Conclusion: Percutaneous treatmentis efficient and safe and offers complete cure in selected patients with the advantage of short hospitalization. Keywords: Drainage, Hydatid Cyst, Liver, Morocco, Percutaneous Puncture, Ultrasound (US)

Surgical management of liver hydatid disease: subadventitial cystectomy versus resection of the protruding dome

The aim of this study was to compare postoperative outcome and long-term results after management of liver hydatid cysts (LHC) by subadventitial cystectomy (SC) and resection of the protruding dome (RPD) in two tertiary liver surgery centers.

Capsulorrhaphy in the management of liver hydatid cyst

Introduction. Hydatid disease is a major health problem in some parts of the world. There are several non-operative and operative ways to treat hydatic disease. The aim of this retrospective study is to assess the rate of postoperative complications, mortality rate, hospitalization period, and recurrence for capsulorrhaphy method, and to compare it with other hydatic cyst management techniques.Material and methods. An open surgical procedure using capsulorrhaphy technique was performed on 250 patients (130 men and 120 women) with uncomplicated hydatic cysts in the Northwest of Iran, between 1989 and 2011. Results. The patients stayed in the hospital between 4 and 10 days, with an average of 5 days. Of the patients, 233 (93.2%) were discharged without any complications, 9 (3.6%) developed a wound infection in the abdominal wall, and 7 (2.8%) developed pulmonary atelectasis. Those who developed an infection or an atelectasis stayed in the hospital for few more days for conservative treatments. One of the patients (0.4%) had external biliary fistula and bile leak, which was treated with surgery and Roux-en-Y cystojejunostomy. During follow-ups (13.2 ± 8.5 months), incisional hernias occurred in 5 (2%) patients and hydatid cyst recurrence affected 7 (2.8) patients. The mortality rate was zero amongst the studied patients.Conclusion. Compared to other techniques in the literature, the results presented in the current work indicate that capsulor-rhaphy is an efficient method in terms of decreased postoperative complications, recurrence, and hospitalization period, and is a safe method with low morbidity and zero mortality rates.

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

The purpose of this study was to determine the safety and efficacy of adjuvant albendazole medication in percutaneous liver hydatid cyst treatment with puncture, aspiration, injection, and reaspiration (PAIR) method. Between November 2007 and May 2011, total of 39 patients with newly diagnosed liver hydatid cyst (total of 77 cysts) were prospectively randomized and enrolled in 3 groups. In the first group, cysts (n = 14) were treated with PAIR without albendazole. In the second (n = 16) and third groups (n = 47), cysts were treated with PAIR with albendazole 1 week before and 1 month after the procedure, with albendazole 1 week before and 3 months after the procedure respectively. Technical and clinical success rates were 100 and 96.1% respectively. In 3 of 77 cysts (3.9%), findings of recurrence were detected on US imaging. All recurrent cysts were in group 1 and recurrence rates in this group were statistically different from cysts of second and third groups (p = 0.005). Side effects of albendazole were detected in 7 of 29 patients (24.1%), and no statistically significant difference was observed between the second (15.3%) and third (38.4%) groups (p = 0.378). Use of albendazole medication as an adjuvant to percutaneous treatment of liver hydatid cyst decreases the recurrence rate. Although there is no statistically significant difference between groups 2 and 3 in terms of efficacy and recurrence rate, patients in group 3 had a higher rate of side effect. Therefore, we conclude that albendazole treatment 1 week before and 1 month after PAIR treatment is sufficient to reduce/prevent recurrences.

What is the Current Concept for the Treatment of Liver Hydatid Disease?

Hydatid disease of the liver caused by the larval form of Echinococcus granulosus still remains a common and challenging problem in Turkey. Operative treatment is the most common and well known option. Percutaneous aspiration, injection and reaspiration (PAIR) has resulted as an alternative treatment to sur¬gery and is becoming popular. Therefore, the treatment of hydatid cyst has been shifted from traditional surgical approach to less invasive PAIR. Large cysts with multiple daughter cysts, cysts communicating with the biliary tree, cysts exerting pressure on vital organs and single superficial hepatic cysts are indications for surgical treatment. While preoperative albendazol treatment is planned to decrease the cyst viability before surgery or percutanaeous drainage, postoperative chemotherapy is administered to reduce recurrence rates. PAIR is a promising treatment approach but randomised clinical trials with long follow-up are required to decide its efficiency. The aim of this study is to evaluate the effectiveness and indications of different treatment modalities in the management of liver hydatid cyst.

The Role of Laparoscopy in the Management of Liver Hydatid Cyst

Surgery is still the main modality in the treatment of hepatic hydatid disease. Laparoscopic methods, with their low morbidity, have gained prominence in many fields and, in some cases, have nearly replaced open surgery. In this report, a laparoscopic method for the treatment of hepatic hydatid disease is described, and the results in the 46 cases are presented and the published articles were reviewed. The method involves laparoscopic cystectomy, pericystectomy, and liver resection for hydatid disease. The postoperative courses of the patients were very comfortable and no complication related to the laparoscopic technique occurred. The postoperative parameters and the early follow-up results (average, 18 mo) are very encouraging. Laparoscopic treatment of liver hydatid disease is safe and effective in selected patients and offers all the advantages of a laparoscopic surgery. In experienced hands, laparoscopic pericystectomy have lower morbidity and recurrence rate compared with cystectomy.

The Only Warrant of Peritoneal Hydatid Cyst Surgery Success Is the Best Choice of the Safest Surgical Approach: Reply

To the editor: We are grateful to Virgilio and colleagues for their interest in our work [1] about peritoneal echinococcosis (PE), and for the two interesting topics they raise in their letter. Preoperative autologous blood donation (PABD) aims to provide a supply of safe blood for patients undergoing surgery who may need blood transfusion; at the same time, it helps increase the patient’s total red blood cell mass due to the PABD-induced stimulation of erythropoiesis before scheduled elective surgery [2]. It is well known that PABD is contraindicated in cases of bacterial infection, even though nothing in the international recommendations about hydatid infection as a contraindication of PABD has been reported. However, the only case of PABD in hydatid cyst (HC) surgery was reported by Roussel et al. [3]. In their article, the authors agreed that PABD has a theoretical risk of dissemination of the hydatid disease, but they were forced to use it exceptionally in this case because of the lack of available blood of the patient’s type and because of the high risk of a large hepatic cyst rupture. Surgical management of PE should be performed safely to avoid intraoperative morbidity or mortality. To avoid hemorrhagic complications when cysts are attached to major vessels, conservative treatment involving drainage and wide deroofing may be recommended. In our university hospital, management of liver HC is based mainly on the use of conservative approaches [4] with very low risk of bleeding. Thus, we do not have any experience with PABD in hydatid cyst surgery. Because there is a lack of scientific evidence regarding its safety in the management of HC, and because of the unacceptable theoretical risk of infectious dissemination after PABD, we think that this technique should be avoided in patients with HC whatever the location. It is widely assumed that the aim of scolicidal agent injection into an unopened HC is to reduce the risk of spillage into the peritoneal cavity and thus to avoid recurrence. Cyst fluid contains thousands of protoscoleces, and each one has the potential to grow into a new HC. In our experience, we routinely use hydrogen peroxide as a scolicidal agent [4] because oxygen peroxide 3 % has proved to be more effective than 20 % saline in many in vitro studies [5]. Moreover, with 20 % saline, many cases of sclerosing cholangitis and hypernatremia have been reported. Hypertonic saline 33 %, used by Virgilio and colleagues, is a higher concentration that can also lead to, at least, cholangitis and hypernatremia. We do not encourage the use of hypertonic saline as scolicidal agent in hydatid cyst surgery without any comparative study of its safety. According to the literature and our experience, PE should be managed in specialized centers to avoid recurrences and surgical morbidity. The only warrant of peritoneal hydatid cyst surgery success is the choice of the safest surgical approach. In our opinion, PABD should not be used, and because hydrogen peroxide is more effective M. A. Majbar F. Sabbah M. Raiss A. Hrora M. Ahallat Clinique Chirurgicale C, Ibn Sina Hospital, 17 Avenue Ibn Rochd, 10000 Rabat, Morocco

RETRACTED: Management of liver hydatid cysts – Current perspectives

Human hydatid disease or cystic echinococcosis (CE), caused by the larval form of cestode Echinococcus granulosus still continues to a common problem in health care environments as different as Europe/North America and resource poor countries of the South America and the East. The Liver is the most frequently parasatized organ in humans. While ultrasonography remains the main diagnostic tool, computed tomography and serology improve the accuracy of diagnosis in Liver hydatid cysts (LHC). Although surgery is the only modality applicable over the entire spectrum of the disease, systemic chemotherapy and percutaneous drainage have evolved as alternative therapies in the last three decades. Various laparoscopic techniques have also been described for safe and optimal management of this entity. In this paper, we review the current management procedures of LHC with particular emphasis on the evidence base and setting specific problems.