Hydatid Cyst Surgery Research Articles

Hepatic Hydatidosis Management

Hydatid cyst disease is a tapeworm infection caused by the larvae of echinococcus granulosus, spread through contaminated water and food. Hepatic hydatid cysts have different clinical manifestations. The investigations include X-rays, ultrasonography, computerized tomography, magnetic resonance, and ERCP used to detect deep lesions in all the organs and extent and status of avascular fluid-filled cysts. An antibody test is done to confirm x-ray findings. The drug Albendazole influences medical treatment. Albendazole chemotherapy proved to be an effective therapy preferred in the medical care of cystic echinococcosis. Radical hepatic hydatid cysts surgery refers to peri-cystectomy, and Conservative surgery removes the cystic contents, sterilizes the cavity, and resects the part of the cyst. Laparoscopic surgery offers the advantages of a short hospital stay, less wound infection incidence rate, and minimal post-operative pain. Percutaneous aspiration injection re-aspiration is suitable in patients who are not fit for surgery or are not ready for the surgery and have multiple cysts in the liver. The conclusion of this review article is compared to open surgery for hepatic hydatid cysts; we have shown that laparoscopic surgery can be performed safely even with multiple cysts, large cysts, and bile duct cysts.

A successful Laparoscopic surgery for multiple hydatid cysts (7 cysts) of liver : Case Report

Case report : To the best of our knowledge this could be the first report of a successfully performed laparoscopic surgery for female patient having had multiple liver hydatid cysts ( 7 in number) in both lobes of liver. Background: Laparoscopic hydatid surgery ( LHS) was almost gaining acceptance all over the world. But still there are contraindications to this approach of particular are those with multiple cysts ( >3 cysts)1.On reviewing the literature most of the reports of LHS were for patients with solitary hydatid cyst and exceptionally for a maximum of three cysts. Herein an initial effort to expand the application of LHS in managing multiple hydatid cysts of liver (>3) with all the advantages of laparoscopic approach; less pain, good cosmetic results, rapid recovery and less complications

HYDATIC CYST OF THE LIVER OR HEPATIC MUCINOUS CYSTADENOMA

Mucinous cystadenomas of the liver are rare cystic neoplasms, often mistaken for simple cysts or hydatid cysts of the liver. They are generally benign tumors, often discovered incidentally on imaging or during independent surgeries. Despite their tendency to grow slowly, mucinous cystadenomas of the liver can reach symptomatic dimensions. And given their potential for malignant transformation into mucinous cystadenocarcinomas, a misdiagnosis can have serious secondary consequences. We report the case of a 55-year-old woman with chronic right hypochondrium pain in whom a mucinous cystadenoma of the liver was accidentally discovered during surgery for hepatic hydatid cyst at the general surgery department at the ARRAZI Hospital - UHC Mohammed VI in Marrakech, Morocco.

Laparoscopic and open operations in the treatment of hepatic echinococcosis. Analysis of short- and long-term results

Aim: to evaluate the short- and long-term outcomes of laparoscopic and open operations in the treatment of hepatic echinococcosis.Materials and methods. The results of laparoscopic and open echinococcectomies performed from 2013 to 2020 were retrospectively studied. Laparoscopic operations were considered the method of choice. Open operations were performed in cases with contraindications to the laparoscopic approach.Results. In total, 57 patients were operated: 47 laparoscopically (including robotic approach in 4 cases), 9 patients underwent open surgery. Radical procedures prevailed among laparoscopic cystectomies: 46 (98%). In the groups of laparoscopic/open cystectomies, partial pericystectomy was performed in 1/3 of patients, subtotal – in 24/4, total – in 13/0, and liver resection – in 9/2 patients, respectively. Laparoscopic procedures were performed mainly for types 1 and 3 of cysts, open procedures – for type 2 (WHO), recurrent and extrahepatic abdominal cysts were indication for open surgery. The frequency of severe complications did not differ between the groups. In the laparoscopic group, 1 (2%) patient died. After laparoscopic cystectomies, the mean (median) hospital stay (8 vs 10 days) and duration of abdominal drainage (10 vs 12 days) were significantly shorter. Relapse occurred only after conservative cystectomies, in one patient in each group.Conclusion. Laparoscopic radical surgery for liver hydatid cysts may be the method of choice if performed in a specialized HPB center. Patient selection criteria should be based on the center's experience in laparoscopic liver surgery.

Capitonnage method selection in pulmonary hydatidosis with purse-string or interrupted suture.

Disfigurements in the lung parenchyma due to capitonnage methods may lead to long-term atelectasis. The aim of the present study was to examine whether there are any complication differences between the capitonnage applied via interrupted suture or purse-string suture. Of the total of 120 cases that underwent hydatid cyst surgery during 2007 and 2020, those that were subject to capitonnage were included in the study. The preoperative and postoperative findings were analyzed for 76 cases subject to purse-string capitonnage (Group I) and 24 interrupted capitonnage (Group II). While the number of cases with complication in Group I was 16 (21.1%), there were only 2 (8.3%) complications in Group II; however, the difference was not statistically significant (P = 0.23). Bronchopleural fistula (n = 1) and prolonged air leak (n = 2) were observed in Group I, there was no bronchopleural fistula or prolonged air leak in Group II. Atelectasis was the most frequently observed complication observed in 12 (15.8%) cases in Group I and 2 (8.3%) cases in Group II (P = 0.53). The duration of hospitalization was lower for the patients in Group II. The number of days was 7.3 ± 2.7 for Group I and 5.3 ± 2.1 for Group II (P < 0.01). This study is the first to compare whether there are any complication differences between the capitonnage methods via interrupted suture or purse-string suture. The results of the study put forth that the duration of hospitalization is lower in the interrupted capitonnage group. Parenchymal anatomy may be preserved better in interrupted capitonnage method.

English

Spillage of protoscoleces within hydatid fluid during surgery for hydatid cyst is the main reason for its recurrence. Therefore, to inactivate the protoscoleces, various scolicidal substances have been tested. However, novel and more efficient agents are needed owing to several associated complications. This study focused on the effects of green synthetic Silver Nanoparticles (AgNPs) from Zizyphus spina- christi leaves on Echinococcus granulosus protoscoleces. Also, to evaluate the blood compatibility of Ag NPs. The Ag NPs were identified by ultraviolet-visible (UV-Visible) spectrophotometer, X-ray diffraction (XRD), Scanning electron microscopy imaging, and Energy-dispersive X-ray spectroscopy (EDX). Hydatid fluid was aspirated aseptically from cysts of infected sheep liver. The protoscoleces were exposed to Ag NPs at several concentrations. Also, scanning electron microscopy for ultrastructural changes and in vitro erythrocytes lysis was performed. The Ag NPs were spherical; the particles' size reached 50 nm, and presented a surface plasmon peak around 460 nm. The current study's findings indicated the powerful in vitro scolicidal efficacy of the green biosynthesized AgNPs. Several morphological alterations were observed on the protoscoleces by optical and scanning electron microscopy. Lysis of RBCs at different doses of Ag NPs was significantly (P≤0.05) less than the positive control value, thus proposing its biocompatibility. This work suggests that chemicals like polyphenols present in the extract of Z. spina- christi act as reducing and stabilizers agents to create Ag NPs Nevertheless, further investigations are needed to investigate the Ag NPs scolicidial effects in animal models.

Iranian Herbal Medicines Against Hydatid Cyst Protoscoleces: A Systematic Review.

In recent years, more attention has been focused in the practice of both crude extract of medicinal plants, and the screening plant-derived compounds as substitute scolicidal agents during hydatid cyst surgery. The present study was designed to review the protoscolicidal effects of some Iranian herbal medicines against hydatid cyst protoscoleces. English databases, including PubMed, Google Scholar, Web of Science, EBSCO, Science Direct, and Scopus were searched for publications worldwide related to protoscolicidal effects of Iranian herbal medicines without date limitation so that identify all published articles (in vitro, in vivo, clinical and case-control) have studied. Keywords included "Protoscolicidal", "Scolicidal", "Herbal medicines", "Extract", "Essential oil", "Plant", "In vitro", and "Iran". Moreover, the language of data collection was limited to English. In total, 40 papers up to 2020 were included in the present systematic review. The most studies were conducted on protoscolicidal activity of methanolic extracts (17 studies) followed by essential oils (15 studies), and aqueous extract (3 studies). The most commonly used part of herbs were leaves (21 herbs), seeds (8 herbs), and fruit (6 herbs), respectively. Moreover, the most prevalent herbal family was Lamiaceae (6 studies), followed by Apiaceae (5 studies) and Liliaceae (5 studies). Considering the high efficacy of Iranian herbal medicines against hydatid cyst protoscoleces, it can be concluded that Iranian herbal medicines have ability to consider as new alternative protoscolicidal agents during hydatid cyst surgery; however, more clinical studies are required to discover the precise protoscolicida activity of Iranian medicines in animal and human subjects.

Insertion of Trocar into the Cyst for Laparoscopic Management of Hydatid Kidney Disease

Abstract Introduction: Renal hydatid cyst operation is usually performed laparoscopically.1–3 In the laparoscopic treatment of the liver hydatid cysts' various methods of entry and drainage are use...

Laparoscopic radical and conservative surgery of hydatid liver echinococcosis. PSM based comparative analysis of immediate and long-term outcomes

The diffusion of laparoscopic radical surgery of hydatid liver echinococcosis remains limited. There no published data on a comparative analysis of the immediate and long-term results of radical and conservative laparoscopic surgery for liver hydatid cysts. Comparison of the immediate and long-term outcomes after laparoscopic radical and conservative cystectomies was aimed. HPB center (center 1) and general surgery hospital in endemic area (center 2) participated in retrospective study. Radical surgery included total, subtotal pericystectomy and liver resection. Conservative surgery comprised cystectomy without/with partial pericystectomy. The total number of patients was 204. Laparoscopic cystectomy was performed in 97 (47%) patients. Radical (n-40) and conservative (n-61) laparoscopic procedures were performed in center 1 and center 2, respectively. Twenty-five pairs of patients were matched. The length of hospital stay and time of abdominal drainage were significantly shorter after radical surgery before and after PSM. The rate of severe morbidity did not differ. The mean follow-up length was 34 and 45 months in center 1 and center 2, respectively. No differences were found in the disease recurrence rate. Laparoscopic radical surgery leads to a reduction in the treatment time and can be recommended as the preferred treatment option in a specialized HPB center.

Pulmonary hydatidosis genotypes isolates from human clinical surgery based on sequencing of mitochondrial genes in Fars, Iran

BackgroundCystic echinococcosis (CE)/hydatidosis is an important neglected parasitic zoonotic disease caused by the metacestode of Echinococcus granulosus s.l. The present study was designed to identify the pulmonary CE species/genotypes in isolated human underwent to surgery in our center in Southern Iran.MethodsThe study population of this study were all patients in Fars province who were admitted to Namazi Hospitals for pulmonary hydatid cyst surgery. Thoracic surgery was performed in the thoracic ward and the cyst/s was removed by open surgery via posterolateral or lateral thoracotomy. DNA was extracted from the germinal layer or the protoscoleces. PCR technique was performed using the cytochrome C oxidase subunit1 (cox1) gene, and the products were sequenced.ResultsA total of 32 pulmonary hydatid cyst samples were collected from 9 (28%) female and 23 (72%) male aged from 4 to 74 years old. A total of 18(56%) cyst/s were in the left lobe and 14 (44%) cysts in the right lobe. Sequence analysis of the cysts showed that 24 samples (75%) were E. granulosus s.s (G1-G3) genotype and 8 (25%) were E. canadensis (G6/G7) genotype.ConclusionE.granulosus s.s genotype was the most prevalent genotype followed by E. canadensis (G6/G7) genotype. There was no significant statistical correlation between cysts’ size, location, genotype strain, and patients’ age and gender.

Modified capitonnage technique for giant pulmonary hydatid cyst surgery.

This study investigated the effectiveness of the modified technique (Aydin Technique), which was applied for capitonnage in the surgical treatment of giant pulmonary hydatid cysts. Twenty-two cases were operated on for giant hydatid cysts with a total of 23 modified techniques for capitonnage (bilateral giant hydatid cyst in 1 case) in our clinic between January 2018 and December 2020. The demographic data were recorded. Thirteen out of 22 (59.1%) of cases were male and 9 (40.9%) were female. The mean age was 22.0 ± 15.8 and 14 cases (63.6%) were children. Hydatid cysts were intact in 13 (56.5%) cases and ruptured in 10 (43.5%) cases. Hydatid cyst diameters were on average 123 ± 21 mm. A modified method was performed for capitonnage in all cases while decortication was performed in 2 (8.7%) cases due to pleural thickening. Radiological atelectasis was observed in 6 cases (27.3%) postoperatively. The patients with atelectasis recovered without any clinical problem and no intervention was needed. In 1 case, an infection developed at the incision site. Postoperative prolonged air leak, empyema and mortality were not observed in any of the cases. The postoperative mean length of hospital stay was 7.18 ± 2.15 days. The mean follow-up period was 19.5 ± 11.5 months. No recurrence was encountered in the follow-up of the patients. The results of this study may suggest to perform this new-described modified Aydin technique to avoid major capitonnage complications of the giant pulmonary hydatid cyst surgery.

Factors Affecting the Choice of Treatment in Hepatic Hydatid Cyst Surgery

Objective We aimed to determine the effective factors in the selection of treatment methods for patients with hepatic hydatid cyst undergoing surgery and the variables effective when performing postoperative endoscopic retrograde cholangiopancreatography (ERCP). In addition, we aimed to reveal the factors affecting the recurrence, postoperative complications, and length of stay of these patients. Materials and methods A total of 107 patients diagnosed with hepatic hydatid cysts were treated surgically. Data were obtained from the records of these patients. Chi-square test was used for the analysis. The variables that were found to be significant in the chi-square analysis were included in the logistic regression (Backward: LR) analysis. Results Of all patients, 6.5% underwent the puncture, aspiration, injection, and reaspiration (PAIR) technique, 67.3% underwent conservative surgery, and 26.2% underwent radical surgical treatment. In paired comparisons, a significant difference was found among the ultrasonographic size of the cyst (p = 0.033), the radiological classification of the cyst (0.006), and history of previous surgery and treatment methods for the cyst. The risk of performing ERCP was 25.710 [95% confidence interval (CI): 1.721–284.013] folds higher for cysts located in the left lobe, whereas it was 19.992 (95% CI: 2.004–199.488) folds higher for cysts located in both right and left lobes. When the radical surgical treatment method was taken as a reference, the status of ERCP implementation was 29.785 (95% CI: 1.844–480.996) folds higher for PAIR and 3.628 (95% CI: 0.355–37.103) folds higher for conservative surgery. Conclusion In conclusion, radical surgery is a significant treatment for hepatic hydatid cyst as its ultrasonographic cyst size increases with time. The location and treatment method of the cyst increases the complication of biliary fistula and requires ERCP.

Comparison of Laparoscopic and Open Surgery in the Treatment of Renal Hydatid Cysts.

Background: To compare the efficacy, safety, and long-term results of laparoscopic and open approaches in patients undergoing surgery for renal hydatid cyst. Materials and Methods: The files of 36 patients who were surgically treated in our clinic and with diagnosis of renal cyst hydatid confirmed pathologically were reviewed. According to the surgical technique applied, the patients were divided into two groups as open (group 1) or laparoscopic (group 2) partial pericystectomy. Oral albendazole was given 10 mg/kg/day (in two divided doses) for 4 weeks preoperatively and for three cycles of 4 weeks at 1-week intervals after surgery in all patients. Demographic characteristics, laboratory and imaging findings, operation times, hospitalization times, complications, intraoperative bleeding amounts, and recurrence rates were statistically compared in both groups. Results: Open partial pericystectomy was performed in 21 patients in group 1, and laparoscopic transperitoneal partial pericystectomy was performed in 15 patients in group 2. Operation time and intraoperative bleeding amount in group 1 and group 2 were 119.6 ± 17.1/116.1 ± 17.6 minutes and 125.7 ± 27.8/113.9 ± 19.2 mL, respectively. There was no statistically significant difference between these values (P = .557, P = .167, respectively). Hospitalization duration of both groups was 5.9 ± 1.4/3.6 ± 0.7 days, respectively. Hospitalization duration in group 2 was statistically significantly shorter (P < .001). No recurrence occurred during postoperative follow-up in either group. Conclusions: In the treatment of renal hydatid cysts, laparoscopy, which is a minimally invasive approach, can be technically applied with the same principles as open surgery and has a similar efficacy and safety profile for short- and long-term results.

The pigtail stenting treatment for the Biliary leakage After the Liver hydatid cyst operation: A case report

Echinococcus granulosis commonly involve the liver and are mostly seen in Turkey . One of the early complication following the surgery for liver hydatid cyst is biliary leakage (B.L.) which’s incidence is %4.5-26. Endoscopic sphincterotomy (E.S.) and biliary stenting are usually successful in treating B.L. In this case, I’m presenting endoscopic treatment for the B.L. after the liver hydatid cyst operation.

Laparoscopic radical and conservative surgery for hydatid liver echinococcosis: PSM based comparative analysis of immediate and long-term outcomes

The diffusion of laparoscopic radical surgery for hydatid liver echinococcosis remains limited. There are no published data on a comparative analysis of the immediate and long-term results of radical and conservative laparoscopic surgery for liver hydatid cysts. Comparison of the immediate and long-term outcomes after laparoscopic radical and conservative cystectomies was aimed. HPB center (Center 1) and general surgery hospital in an endemic area (Center 2) participated in a retrospective study. Radical surgery included total, subtotal pericystectomy, and liver resection. Conservative surgery comprised cystectomy without/with partial pericystectomy. The total number of patients who underwent surgery for liver hydatid cysts was 213. Laparoscopic cystectomy was performed in 106 (50%) patients. This number included 47 radical laparoscopic cystectomy (Center 1). Conservative laparoscopic procedures were used in 59 patients (Center 2). Finally, twenty-seven pairs of patients were matched. Immediate outcomes were better for radical treatment in terms of severe morbidity, length of hospital stay, and time of abdominal drainage before and after PSM. The mean follow-up length was 23 (4-66) and 29 (6-66) months and the recurrence rate was 2% and 5% in groups of radical and conservative treatment respectively. No differences were found in 1-, 3-, and 5-year disease free survival. After second PSM for recurrence, 20 pairs were matched with no relapse of disease. Laparoscopic radical surgery leads to the better immediate outcomes and can be recommended as the preferred treatment option in a specialized HPB center. Conservative option is justified in general hospitals in endemic area for selected uncomplicated cysts.

Chemical Composition, Apoptotic Activity, and Antiparasitic Effects of Ferula macrecolea Essential Oil against Echinococcus granulosus Protoscoleces

Background: Today, the present protoscolicidals used to minimize the serious risks during hydatid cyst surgery are not completely safe and have various adverse side effects. The present study aimed to evaluate the chemical composition and apoptotic activity of Ferula macrecolea essential oil (FMEO) as well as its in vitro and ex vivo protoscolicidal effects against hydatid cyst protoscoleces. Methods: Gas chromatography/mass spectrometry (GC/MS) analysis was performed to determine the chemical composition of FMEO. Protoscoleces of hydatid cysts were collected from liver fertile hydatid cysts of infected sheep and were then treated with various concentrations of the essential oil (75, 150, and 300 µL/mL) for 5–60 min in vitro and ex vivo. Then, by using the eosin exclusion test, the viability of the protoscoleces was studied. The caspase-3-like activity of the FMEO-treated protoscoleces was also evaluated through the colorimetric protease assay Sigma Kit based on the manufacturer’s instructions. Results: According to GC/MS, the main constituents of the essential oil were terpinolene (77.72%), n-nonanal (4.47%), and linalool (4.35%), respectively. In vitro, the maximum protoscolicidal activity of FMEO was observed at the concentrations of 150 and 300 µL/mL, such that 100% of the protoscoleces were killed after 30 and 20 min of exposure, respectively. Based on the obtained findings, the results demonstrate that FMEO required a longer time to kill protoscoleces ex vivo; after 12 min of exposure to FMEO, only 13.4% of the protoscoleces remained alive. After 48 h of the treatment of protoscoleces, FMEO, in a dose-dependent manner and at doses of 75, 150, and 300 µL/mL, induced the activation of the caspase enzyme by 24.3, 35.3, and 48.3%, respectively. Conclusions: Our findings demonstrate the potent protoscolicidal effects of FMEO in vitro and ex vivo; however, further studies are required to assess the safety and the efficiency of FMEO as a promising scolicidal agent in a preclinical model and clinical setting.

Effective Factors on the Disappearance of Residual Cavity Following Conservative Surgery of Liver Hydatid Cysts.

Background:Surgery is one of the treatments commonly used to treat liver hydatid cyst. Remaining of the residual cavity after conservative surgery may lead to some harmful complications. In this study, we evaluated the role of different factors affecting the disappearance of the residual cyst.Materials and Methods:Seventy-five patients were evaluated in 2.5 years. Patients were divided into two groups based on the remaining or disappearance of the residual cavity in follow-up visits. The baseline demographic features, preoperative cysts’ size, type of technique used to eliminate the residual cavity, and cavity wall characteristics were compared in the two groups.Results:Residual cavity was disappeared in 46 (61%) patients after 2 years. Calcification of the wall and wall stiffness were more common in patients with the remained residual cavity (89.6% vs. 8.7% [P < 0.001] and 58.6% vs. 30.4% [P < 0.01], respectively). Demographic features, preoperative cysts’ characteristics, and the procedure used during surgery were not statistically different between groups.Conclusions:Cyst wall calcification and wall stiffness had a role in predicting residual cavity disappearance. These factors can help surgeons to predict patients at higher risk of posthydatid cyst resection residual cavity.

Radical Surgery in Liver Hydatid Cyst with Transdiaphragmatic Rupture and Lung Hydatid Cyst

Radical Surgery in Liver Hydatid Cyst with Transdiaphragmatic Rupture and Lung Hydatid Cyst

Evaluating Giant Hydatid Cysts: Factors Affecting Mortality and Morbidity.

Objective: The aim of this study was to evaluate the prognostic factors affecting morbidity and mortality among patients who underwent surgery for giant pulmonary hydatid cysts in our center.Methods: Data from 283 patients who underwent surgery in our center for pulmonary hydatid cyst between 2008 and 2018 were retrospectively analyzed. Cysts 10 cm in diameter or larger were considered giant hydatid cysts.Results: There were 145 women (51.2%) and 138 men (48.8%). Giant cyst (≥10 cm) was present in 57 patients (20.1%), while the other 226 patients (79.9%) had cysts smaller than 10 cm. Operations were performed using videothoracoscopic approach in 68 patients (24%) and with thoracotomy in 215 patients (76%). Hydatid cysts were on the left side in 129 patients (45.6%), on the right side in 143 patients (50.5%), and bilateral in 11 patients (3.9%). Postoperative morbidity occurred in 29 patients (10.2%). Use of videothoracoscopic surgical approach did not affect morbidity. The mortality rate within the first 90 days was 0.35% (n = 1).Conclusion: Giant cysts are more common in the young age group than in older adults. Regardless of cyst size, surgery should be performed as soon as possible after diagnosis to avoid potential complications.

Outcome of Biliary Fistula After Liver Hydatid Cyst SurgeryHydatid cyst, biliary fistulae, Outcome, surgery.

Background: Biliary fistula after liver hydatid cyst surgery was occur in about 17.8 percent of patients inour center.Objective: To study the outcome of biliary fistula regarding factors related to its causes and management.Patients and Methodology: This is a prospective study of 241cases submitted to liver hydatid surgery inAl-Sader teaching hospital in Al-Najaf city, from October 2015 to April 2019. A total of 43 patients whounderwent surgery complicated with persistent leakage of bile from externaldrain. Prospectively collecteddatabase were gathered from patients medical records,sent for essential investigations, and treated eitherconservatively to give a chance for spontaneous closure, or by intervention with ERCP.Results: Forty three patients who develop postoperative biliary fistula after hydatid cyst surgery from 241patients(17,8 %),230 patients treated with conservative surgery (95,4 %), 2 patients treated with radicalsurgery(0,82 %) and 9 patients treated with percutaneous aspiration injection reaspiration (3.7%).All the 43patients in this search treated with conservative surgery. Size more than 15 cm is a risk factors. Intraoperativerisk factor is mainly presence of cystobiliary communication which occur in 16 patients (37,2%). Treatment;isconservative in about 23 patients(53.4%).Treatment with ERCP in 19 patients (44.1%).Time of interventionis from 9 – 15 days.Conclusion: Most of patient with external biliary fistula after hydatid liver surgery can be treatedconservatively and resolve spontaneously specially low output fistula.