Treatment Of Hepatic Hydatid Cysts Research Articles

Advantages of Laparoscopic Treatment in Hepatic Hydatid Cyst and Current Therapeutic Management

Abstract This 7-year retrospective study presents our results on the laparoscopic treatment of hepatic hydatid cysts, with the aim of demonstrating the advantages of minimally invasive surgery, safety and efficacy of the procedure. The study group included 33 patients, 22 female and 11 male, aged 20-74 years, who were diagnosed and subsequently underwent laparoscopic surgery. Diagnosis was based on history, clinical examination and biological, imaging investigations (abdominal ultrasound, CT scan of the abdomen). The results of the study reveal a female predominance, the highest number of patients was recorded between the age group 61-70 years, while the second place was occupied by the age groups 31-40 and 51-60 years. The most common symptom was abdominal pain. The surgical procedure used was laparoscopic Lagrot partial perichystectomy. Case conversion was required in eight patients. Based on our experience, we can state that laparoscopic surgery in the treatment of hepatic hydatid cyst is safe, effective and plays an essential role in the management of hepatic hydatid disease, with proven advantages over surgeries performed by the classical route.

Predictive factors of occult cystobiliary fistulas during conservative treatment of hepatic hydatid cyst: a prospective study

BackgroundOccult cystobiliary fistula (CBF) is a common complication of hepatic hydatid cyst (HHC). It is often the cause of high morbidity of conservative treatment of HHC. This study aimed to determine the predictive factors of occult CBF to establish the indications for the investigation and treatment of these CBFs. MethodsThis was a prospective study that included all operated HHCs over a 3-year period. HHCs complicated with large CBFs were not included in the study. Systematic cholecystectomy and methylene blue test for all cysts were performed. ResultsA total of 46 patients operated on with 113 cysts were included in this study. The median cyst size was 6.7 cm (IQR, 1-38). A total of 114 CBFs were detected in 51 cysts (45.1%). The postoperative course was simple in 95.0% of cases. The specific morbidity rate was 2.7%. In a bivariate study, absence of mass and abdominal pain on palpation, hemoglobin level >11.55 g/dL, negative hydatid serology, cyst size, absence of calcifications, vascular compression, existence of a single cyst, and localization at segment VIII were predictive factors of occult CBF. At the end of the multivariate study, cyst size was determined to be the only predictive factor for occult CBF. A threshold of 3 cm was used. ConclusionCyst size is a major predictive factor for occult CBF.

Minimally invasive treatment of hepatic hydatid cysts complicated by the rupture into the biliary tract

The paper presents the clinical observations of the rare complication of hepatic hydatid disease: the rupture of hydatide cysts into the bile ducts. The complication causes obstruction of the bile ducts, obstructive jaundice, and cholangitis. The basic stages of diagnosis and the role of ultrasound in detecting the complications of hepatic hydatid disease have been highlighted in this paper. The minimally invasive percutaneous and endoscopic techniques under radiological guidance have been reviewed.

PAIR. Percutaneous Treatment of Hepatic Hydatid Cyst: A Case Report

Cystic Hydatidosis is a zoonosis caused by the Echinococcus Granulosus. The most affected solid organ is the liver (70% -80%). The best treatment, surgery, percutaneous drainage or medical treatment (albendazole) has not yet been defined, and in all cases, the individuality of each patient (age, comorbidities, size and location of the cyst) must be taken into account. In 1985, QHH puncture was published as a therapeutic option. Since then, PAIR treatment (puncture, aspiration, instillation of scolicide and re-aspiration) has established itself as a valid treatment.

Results of Minimally Invasive Methods in the Treatment of Liver Hydatid Cyst

Objective: The most common cause of hydatid cyst disease is Echinococcus granulosus. Nowadays, minimally invasive methods such as laparoscopy used in the treatment of hepatic hydatid cyst (HHC). In this study, it is aimed to share the clinical, surgical and postoperative data of patients who underwent laparoscopic surgery with a diagnosis of HHC in our clinic.
 Methods: Data of 105 patients who underwent laparoscopic surgery for HHC between January 2011 and January 2020 were retrospectively analyzed. Patients who were diagnosed with HHC by clinical, indirect hemagglutination test, upper abdominal ultrasonography (USG) and upper abdominal tomography were included in the study. All patients received 10 mg / kg / day albendazole therapy for a total of six weeks, two weeks preoperatively and four weeks postoperatively. Demographic information, clinical characteristics, and the incidence and percentage of complications were analyzed by simple manual calculation.
 Results: 64 (60.95%) of 105 patients who underwent laparoscopic surgery were male and 41 (39.05%) were female. The mean age was 40.6 ± 11.7 years (18-65 age range). The mean cyst diameter was 8.4 cm in size (minimum: 6 cm, maximum: 16 cm). The mean operation time was 55 ± 11.45 minutes (Range: 42 to 70 minute). The mean hospitalization period of the patients was 3.7 days (Range 2 to 7). No recurrence was observed in the 18-month follow-up of the patients.
 Conclusıons: HHC is a common disease in our country, and we think that laparoscopic approach is an effective surgical treatment option in suitable patients and in experienced centers.

Treatment of Hepatic Hydatid Disease: Role of Surgery, ERCP, and Percutaneous Drainage: A Retrospective Study.

Failure to follow the World Health Organization's Informal Working Group on Echinococcosis guidance or having limited experience in the management of cystic echinococcosis (CE) in endemic or nonendemic areas of the world may lead to risky unnecessary procedures. Medical records of all patients undergoing surgery for hepatic hydatid disease at the gastroenterologic surgery and general surgery departments of our hospital between December 2014 and October 2019 were collected and reviewed retrospectively. Demographic characteristics, the size and number of the cysts preoperative liver function tests, surgical treatment, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage (PD), morbidity, and treatment outcomes were reviewed. Of 122 patients included in the study, 77 (63, 1%) were female and 45 (36, 9%) were male individuals and their mean age was 44.95 years. CE1 was identified in 13 patients (10.6%) CE2 in 66 patients (54.1%), CE3a in 7 patients (5.8%), CE3b in 28 patients (22.9%), and CE4 in 8 patients (6.6%). Twenty patients (16.4%) with a cystobiliary fistula in the liver, obstructive jaundice, and postoperative bile leak underwent ERCP. PD was performed in patients with fluid in the hepatic hydatid cyst pouch, increased pouch size because of bile collection, and clinical symptoms postoperatively. Patients presenting with persistent bile leak despite PD underwent ERCP and were treated with endoscopic sphincterotomy and stent placement. Patients with PD were followed by keeping the percutaneous drain open and closed for a while to create pressure difference in the cyst pouch after ERCP. The percutaneous drain was removed in the next 14 to 21 days after checking the pouch size, whereas the common bile duct stents were removed 2 months later after performing a follow-up cholangiography. ERCP should be the primary method for the diagnosis and treatment for hepatic hydatid cysts ruptured into the ducts. İn some cases, high-flow hydatid cysts with rupture into the bile ducts or persistent biliary fistulas can be treated with ERCP and endoscopic sphincterotomy, biliary stent, PD, and nasobiliary drainage without the need for surgical intervention.

Resultados clínicos y económicos de la cirugía laparoscópica versus abierta en el tratamiento del quiste hidatídico hepático

Resultados clínicos y económicos de la cirugía laparoscópica versus abierta en el tratamiento del quiste hidatídico hepático

Percutaneous Aspiration-Injection-Reaspiration of Hepatic Cystic Echinococcosis

Human echinococcosis is a zoonotic infection caused by larval forms (metacestodes)of the tapeworm of the genus echinococcus found in the small intestines of carnivores. Humans are only incidentally infected. The liver is the most frequent site for the cystic lesions seen in hydatid disease, followed by the lung, the brain, and other visceral. Surgery is the recommended treatment for hepatic hydatid cysts. However, drug therapy and percutaneousdrainage have recently been introduced as alternative treatments. We present the case of a 68 year old female pacient that admitted in our clinic for pain in the superior abdominal region. The ecography performed revealed a large cystic formation about 700 mL with a diameter of 10 cm in the right lobe of the liver. We performed a Percutaneous Aspiration-Injection-Reaspiration Drainage (PAIR) under Albendazol treatment before and after the procedure without any incidents. The histopathological examination concluded the diagnosis of hydatid hepatic cyst. Percutaneous drainage is minimally invasive and very effective in the treatment of hepatic hydatidosis. Percutaneous aspiration of a documented or suspected hydatid cyst was long considered to be contraindicated to avoid the risk of leakage of cyst contents, which can lead to anaphylaxis and seeding of intraperitoneal structures. In the our case report the hydatid hepatic cyst was a large univezicular cyst, with a approachable localization in the liver, on a pacient without any other medical problems that was suitable for PAIR, and after the procedure we didn�t identified any of the complication reported in literature. The effectiveness of PAIR method allowed a short period of hospitalization with ambulatory follow up with benefits on the both sides , the pacient social integration and medical system economy.

The Use of Radiofrequency Thermal Ablation Method in The Treatment of Hepatic Hydatid Cysts: Ex vivo Sheep Study

Hydatid disease is a disease caused by parasites belonging to the echinococcus family. This disease is often caused by Echinococcus granulosus and rarely by echinococcus alveolaris.The parasite may cause illness anywhere in the human body, mainly in liver. In this study, we aimed to destroy the hydatid cyst viability by Radiofrequency Thermal Ablation (RFTA) method which has been used in many areas in medicine. We used fresh sheep liver with hydatid cysts. Average diameter of cysts was 3.3 cm. The study was performed in 3 groups, each of which involved 20 cysts. After more than half of the cyst fluid was drained, ablation was performed. When the core temperature of the cyst exceeded 95°C, ablation procedure was continued for 3 minute in 1st group and for 4 minutes in 2nd group. Third group was the control group. And then, cyst fluid and germinative membrane were collected for microbiologic and pathologic assessment. In 1st group, the cysts could not be destroyed at the desired level. In 2nd group, it was observed that 100% of the protoscolex died and 100% of the germinative membranes was degenerated. In control group, %13 of protoscolex died and %10 of germinative membranes wasdegenerated. We destroyed all the protoscolex and germinative membranes by using RFTA in 2nd group.

Operative treatment of hepatic hydatid cysts: A single center experience

Hydatid cyst is a zoonotic disease caused by Echinococcus genera. Surgery is needed in most cases. We aimed to describe our center's experience in the surgical management of hepatic hydated cysts (HHC). Data was retrospectively collected for patients who underwent operative management for HHC between the years 1994-2014. Sixty-nine underwent surgical treatment for HHC. Group A included 34 treated with an unroofing procedure, group B included 24 patients who underwent hepatectomy and group C included 11 patients who underwent peri-cystectomy. The median±(range) age for groups A, B and C were 39.5 (6.5-69), 40 (17-74) and 32 (20-62), respectively (P>0.1). Post-operative complications occurred in 16, 11 and 5 patients in group A, B and C, respectively, as assessed by clavien-dindo classification (CDC). The average CDC was significantly higher in the hepatectomy group as compared to the unroofing group (2.3 vs.1.5, P=0.04). Recurrence was significantly higher after the unroofing procedure as compared to the hepatectomy group (P=0.05). Surgery remains the mainstay of treatment for HHC, once surgery is pursued, the results are satisfactory.

Operative treatment of hepatic hydatid cysts in non endemic region: a single center experience

Operative treatment of hepatic hydatid cysts in non endemic region: a single center experience

Comparison of mid-term clinical outcomes of laparoscopic partial cystectomy versus conventional partial cystectomy for the treatment of hepatic hydatid cyst.

Background:The aim of this study was to compare the mid-term outcomes of open and laparoscopic partial cystectomy (LPC).Methods:The medical records of patients who underwent conventional partial cystectomy (CPC) and LPC for liver hydatid cyst from May 2010 to February 2015 were retrospectively reviewed. Operative time, blood loss, length of hospital stay, post-operative morbidity, mortality and mid-term follow-up outcomes were evaluated.Results:Amongst 130 patients, 38 patients were underwent LPC and 92 underwent CPC. Blood loss and post-operative complications were similar in both groups. The mean operative time in the LPC and the CPC groups was, respectively, 95.4 ± 13.1 and 63.5 ± 15.6 min, which showed a significant difference between the both groups. The mean length of hospital stay in CPC group was significantly longer when compared the LPC group. The mean diameter of cyst in LPC group was 6.1 ± 1.1 cm and 7.8 ± 2.1 cm in CPC group with a significant difference. The overall complication rates were 13.1% in LPC group and 17.3% in CPC group without significant difference. The most common complication was biliary leakage and surgical site infection.Conclusion:LPC for the surgical treatment of liver hydatid cyst appears to be safe and effective method with low morbidity rates in selected patients.

Laparoscopic treatment of hepatic hydatid cyst

Laparoscopic treatment of hepatic hydatid cyst

Laparoscopic management of hydatid cyst of liver

Background and Objectives: The surgical treatment of liver hydatid disease has evolved dramatically and laparoscopic treatment has shown encouraging results with the advantages of minimally invasive surgery. We conducted this study to determine the outcome of laparoscopic management of hydatid disease of the liver.Methods: Consecutive patients with this disease reporting to our department from July 2014 to July 2015 were offered laparoscopic management. All patients received pre- and postoperative albendazole. The laparoscopic technique consisted of aspiration of the cyst fluid, sterilization, suction and drainage of the cavity, deroofing and addition of omentoplasty. Age, sex, duration of surgery, surgical morbidity, hospital stay and evidence of hydatid cyst recurrence were measured.Results: Twenty six patients had laparoscopic treatment for hepatic hydatid cysts. Females were 18 (69.2%) and males were 8 (30.8%). Mean age of patients was 37.46 ± 15.96 years (range 17-74 years). Pain was the commonest presentation occurring in 21 (80.8%).The right lobe of the liver was most commonly involved in 20 patients (76.9%). The mean cyst size was 6.77 cm (range, 5 cm to 12 cm). Minor spillage of cyst contents occurred in 5 patients (19.23%) and major spillage occurred in 1 patient (3.8%). The mean duration of surgery was 84.81 ± 28.93 minutes (range 50 – 150 minutes). Conversion was needed in 2 (7.7%). Complications included portsite infection in 2 (7.7%), bile leak in 3 (11.5 %), fever in 5 (19.2%) and chest infection in 2 (7.7%) cases. Mean hospital stay is 4.58 ± 3.40 days (range 3-16). There was no mortality in the series. The average follow-up period is 7.81 ± 2.57 months. There have been no recurrences to date however 1 patient was lost to follow up.Conclusion: Laparoscopic management of hydatid cysts of the liver is a safe and effective option with advantage of minimally invasive surgery in properly selected patients.

Clinical and serological outcomes with different surgical approaches for human hepatic hydatidosis.

Hydatidosis is the result of infection with the larval stages of some species of the genus Echinococcus. Treatment approaches for hydatid cysts include the use of albendazole, surgery, and/or medico-surgical procedures. The choice of the therapeutic surgical approach depends on the cyst number and localization, surgeon expertise, and presence of complications. The present study aimed to compare the outcomes of the following therapeutic approaches for the treatment of hepatic hydatid cysts: pericystectomy; the puncture, aspiration, injection, and reaspiration (PAIR) technique; and the PAIR technique followed by deroofing, evacuation of cysts, and omentoplasty. The 54 patients were divided into 3 groups: Group I (14 patients) who underwent pericystectomy, Group II (23 patients) who underwent the PAIR technique, and Group III (17 patients) who underwent the PAIR technique followed by deroofing and omentoplasty. The diagnosis of hydatid cysts was based on serological testing using enzyme-linked immunosorbent assay, abdominal ultrasound, and parasitological examination of the cyst contents. Morbidity, mortality, length of hospital stay, recurrence, and postoperative complications were evaluated. Postoperative bleeding, infection, and recurrence were reported in Groups I and II; Group III did not experience postoperative infection and had shorter hospital stays. Recurrence and postoperative complications did not occur in Group III. The partial surgical procedure with deroofing, evacuation of the cysts, and omentoplasty, as performed in the present study, is recommended as a safe and effective method for elimination of the entire parasite with minimal possibility for intra-peritoneal spillage.

Clinical and Serological Outcomes in Different Surgical Approaches for Hepatic Human Hydatidosis

Background: Cystic echinococcosis or hydatidosis occurs as a result of infection by the larval stages of Ecchinococcus granulosus. Treatment approaches of hydatid cysts include the use of albendazole, surgery and/or medico-surgical procedures. Objective: The present study aimed to investigate and evaluate partial pericystectomy, PAIR technique and combined PAIR technique followed by deroofing, evacuation of cysts and omentoplasty as three therapeutic approaches for treatment of hepatic hydatid cysts. Methodology: The study was conducted on 54 patients presenting with hepatic hydatid cysts. Patients were included in 3 groups: group I (14 cases) subjected to partial pericystectomy, group II (23 cases) subjected to PAIR technique and group III (17 cases) subjected to PAIR technique followed by deroofing of the cysts and omentoplasty. Diagnosis of hydatid cysts was based on serological testing by ELISA, abdominal ultra-sound examination and parasitological examination of cysts contents. Morbidity, mortality, hospital stay, recurrence and postoperative complications were evaluated for each surgical procedure. Results: Postoperative bleeding, infection, recurrence and prolonged hospital stay were reported in group I subjected to pericystectomy. Recurrence and postoperative bleeding were reported in group II with no postoperative infection and less hospital stay. No recurrence or postoperative complications were reported in cases included in group III. Conclusion: Partial surgical procedure with deroofing, evacuation of cysts and omentoplasty performed in this work is recommended as a safe and effective method for entire elimination of parasite with minimal possibility for intra-peritoneal spillage.

News in the Treatment of Hepatic Hydatid Cyst

News in the Treatment of Hepatic Hydatid Cyst

Operative Treatment of Hepatic Hydatid Cysts: A Single Center Experience in Israel, a Nonendemic Country

Background. Hydatid cyst disease is a zoonosis caused by Echinococcus genera. The disease is endemic to certain rural areas in the world. Operative treatment is the main component in curing hydatid cysts of the liver. Objective. Describing the unique characteristics of the hydatid cyst patients in Israel, a nonendemic country. Methods. Data was collected form 29 patients treated operatively in Rabin Medical Center from 1994 to 2007. Results. The study included 18 females and 11 males with an average age of 54.9 years. Fifty-two% of the patients immigrated as children from Arab countries to Israel, 21% were Arab-Israelis leaving in the north and center of Israel, and 24% immigrated from the former Communist Bloc. Pericystectomy was performed in 20/29, and cyst unroofing was performed in 9/29. Hydatid cysts average size was 10.7 cm, and the cysts were located in the right or left or involved both lobes in 62%, 28%, and 10% of the lesions, respectively. Postoperative mortality occurred in one case, and severe morbidity occurred in 4 patients. Conclusions. Hydatid cyst disease in Israel is uncommon and is mostly seen in distinct 3 demographic groups. Despite the relatively low patient volume, good results in terms of morbidity, mortality, and recurrence were achieved.

Predictive factors of morbidity after surgical treatment of hepatic hydatid cyst

Predictive factors of morbidity after surgical treatment of hepatic hydatid cyst

Is Hepatic Resection the Best Treatment for Hydatid Cyst?

BackgroundHydatid disease is a serious public health problem in endemic areas, and the management is controversial. Operative treatment is generally accepted especially in patients presenting complications. Our policy is to perform radical surgery and, whenever possible, anatomic hepatic resection. The purpose is to report our experience and results in the management of liver hydatid disease. MethodsBetween January 1991 and December 2010, 97 patients were referred to our department for surgical treatment of hepatic hydatid cyst. Data were retrospectively reviewed. Patients were divided into three treatment groups: conservative surgery (CS), total pericystectomy (PC), and hepatic resection (HR). The main outcome measures were the mortality, morbidity, and recurrence rate. ResultsMedian patient age was 45 years (range, 30–56 years). A total of 105 hydatid cysts were treated. Radical surgery was performed in 85 patients: major HR in 43 patients, minor HR in 9, and total PC in 33. CS was performed in 12 cases. There were no postoperative deaths, and the overall morbidity was 20 %. Postoperative morbidity in the HR group was 20 %. Minor (Grade I/II) and major (Grade III/IV) complications were comparable between groups (p = ns). No statistical difference in duration of hospitalization was observed between the CS and the HR group. One patient in the HR group developed a recurrence. ConclusionsThe findings of this study suggest that surgical resection is not associated with much more postoperative and cyst cavity-related complications than the other groups. In addition, there was no mortality and a low recurrence rate.