Treatment Of Hepatic Hydatid Cysts Research Articles

Laparoscopic treatment of hepatic hydatid disease

Hepatic hydatid disease is now rare in Australasia. However, it remains a significant problem in endemic areas. Many cases are now managed using minimally invasive techniques and this paper reviews the current status of laparoscopic approaches to hepatic hydatid disease. A Medline data search was performed using the search terms of Ecchinococcos, laparoscopy, hepatectomy and pericystectomy. All publications from all publication years, including foreign language publications, were included. Eight series have been published comprising five or more patients, with most utilizing techniques of laparoscopic cystectomy. All series managed Gharbi cyst types I-IV, and median operative times were between 60 and 82 min. Seven conversions were reported (3%) for problems with access or bleeding. There was one reported fatality, and between 5% and 45% (median 13%) of patients developed complications. Three cases of anaphylaxis were reported and 14 cases of bile fistula were reported (median incidence: 6%). Hospital stays were between 3 and 10 days (median stay: 3.5 days). Two series report recurrences (recurrence rates of 3% and 4%) and these were in patients not treated with preoperative albendazole. Laparoscopic surgical techniques have been successfully applied to the treatment of hepatic hydatid cysts. While the uptake of these procedures is limited to areas of high prevalence and units with a specific interest, laparoscopic surgery is now one of the management options available to treat hepatic hydatid disease.

Laparoscopic treatment of hepatic hydatid cyst.

To determine the outcome of laparoscopic management of hepatic hydatid disease in terms of complications. Case series. Surgical C Unit, Khyber Teaching Hospital, Peshawar, from February 2007 to March 2010. All patients with 3 or less hepatic hydatid cysts who underwent laparoscopic treatment for hepatic hydatid cyst disease were included during the study period. Laparoscopic aspiration, unroofing and evacuation of the hepatic hydatid cysts was done. Clinicopathologic features, operative time, conversion to laparotomy, morbidity, mortality and recurrence rates were analysed. Forty three patients had laparoscopic treatment for hepatic hydatid cysts. Females were 27 (62.79%) and males were 16 (37.20%). Mean age of patients was 38.6 ± 14.03 years (range 15-64 years). Pain was the commonest presentation occurring in 34 (79.06%) and mass in 9 (20.93%). Hepatic hydatid cysts were successfully treated laparoscopically in 40 patients. Open surgery conversion was needed in 3 (6.97%) due to inadequate access. The mean duration of surgery was 46.27 ± 13.84 minutes. Complications included port-site infection in 3 (6.97%), bile leak in 4 (9.30%) and recurrence in 2 (4.65%) cases; there was no mortality in the series. Laparoscopic hepatic hydatid cyst surgery was a safe and effective method in selected patients.

Laparoscopic versus Open Management of Hydatid Cyst of Liver

Background: To compare laparoscopic versus open management of the hydatid cyst of liver regarding recurrence rate, the surgical approach to liver echinococcosis is still a controversial issue. This study shows our results of surgical treatment of liver hydatid cysts during a 5 years period. Methods: A prospective study of 32 patients operated on in a 5-year period (1999-2003) in Dubrava University Hospital, Zagreb, Croatia, with hepatic hydatid cyst. All patients were preoperatively treated with albendazole. In 32 patients, total pericystectomy without opening the cyst cavity was performed laparoscopically, other procedures were used as surgical approach. Results: There was no mortality after 5 to 6 months follow-up, but in one patient, in the open partial pericystectomy group, recurrence of the disease occurred after 2 to 3 years. When a laparoscopic procedure was done, there were no complications or recurrence. The median operative duration for open surgery was 100.0 minutes (range 60.0-210.0) and for laparoscopic surgery 67.5 minutes (range 60.0-120.0). The median length of hospitalization for open surgery was 8.0 days (range 7.0-14.0) and for laparoscopic surgery 5.0 days (range 4.0-7.0). Conclusion: Total pericystectomy without opening the cyst cavity, preceded by preoperative albendazole therapy is the method of choice for hepatic hydatid cyst treatment. Despite the small group of patients, our first results show laparoscopic total pericystectomy, without opening the cyst cavity, in the treatment of hepatic hydatid cyst.

Percutaneous aspiration and drainage with adjuvant medical therapy for treatment of hepatic hydatid cysts

To determine the efficacy and success of percutaneous aspiration irrigation and reaspiration (PAIR) in the management of hepatic hydatidosis. Twenty-six patients with 32 hepatic hydatid cysts had PAIR. Twenty-two patients received at least 2 wk of drug therapy before the procedure was carried out to reduce the risk of recurrence from spillage during the procedure. The procedure was performed under local anesthesia with a 19-gauge 20 cm long needle, the cyst was punctured, cystic content (approximately 30 mL) was aspirated by a 12-14 F pigtail catheter and aspirated fluids were sent for analysis. Once the cyst was almost empty, two-thirds of the net amount of material aspirated was replaced by hypertonic saline and left in the cavity for about 30 min, with the catheter left in place for reaspiration of most of the fluid. When the amount of fluid drained was less than 10 mL per 24 h, the drainage catheter was removed. All 32 cysts showed evidence of immediate collapse after completion of the procedure, and before discharge from hospital, ultrasound examination showed fluid reaccumulation in all cysts. Serial follow-up showed a progressive decrease in the size and change in the appearance of cysts. To confirm the sterility of these cystic cavities, seven cysts were reaspirated on average 3 mo after the procedure. Investigations revealed no viable scolices. PAIR using hypertonic saline is very effective and safe with proper precautions.

Tratamiento laparoscópico de los quistes hidatídicos hepáticos: técnicas y complicaciones postoperatorias

Introduction We evaluate our experience in the surgical laparoscopic treatment of hepatic hydatid cysts with the same criteria that we use in open surgery. Material and methods A retrospective study of 8 operated patients and their intra- and postoperative complications. Results We performed the scheduled surgery on 7 patients; bleeding was the reason for conversion to open surgery in the remaining one. We made 4 complete peri-cystectomies, 3 de-roofing and 1 hepatic resection. Two patients had postoperative bile leaks: the first one had an external leak that needed an endoscopic sphincterotomy and the other developed an abscess that needed reintervention for drainage. This patient also had a right hepatic vein thrombosis that disappeared spontaneously. Finally, 3 patients had hypernatremia without clinical symptoms. Conclusions Many of the open surgery techniques for hepatic hydatid cysts can be performed laparoscopically, without any specific instruments. Our complications with laparoscopic treatment of hepatic hydatid cysts were similar to those of open surgery.

Laparoscopic treatment of hepatic hydatid cysts: techniques and post-operative complications

IntroductionWe evaluate our experience in the surgical laparoscopic treatment of hepatic hydatid cysts with the same criteria that we use in open surgery. Material and methodsA retrospective study of 8 operated patients and their intra- and postoperative complications. ResultsWe performed the scheduled surgery on 7 patients; bleeding was the reason for conversion to open surgery in the remaining one. We made 4 complete peri-cystectomies, 3 de-roofing, and 1 hepatic resection. Two patients had postoperative bile leaks: the first one had an external leak that needed an endoscopic sphincterotomy and the other developed an abscess that needed reintervention for drainage. This patient also had a right hepatic vein thrombosis that disappeared spontaneously. Finally, 3 patients had hypernatremia without clinical symptoms. ConclusionsMany of the open surgery techniques for hepatic hydatid cysts can be performed laparoscopically, without any specific instruments. Our complications with laparoscopic treatment of hepatic hydatid cysts were similar to those of open surgery.

First Successful Puncture, Aspiration, Injection, and Re-Aspiration of Hydatid Cyst in the Liver Presenting with Anaphylactic Shock in Korea

Hydatid disease is a parasitic infestation caused by the larval form of Echinocococcus. In human, the most commonly affected organs are liver and lung. Most cysts remain clinically silent and are diagnosed incidentally or when complications occur. In Korea, hydatid disease is rare and surgically treated cases have been reported in the Korean literature. However, it is expected to confront this disease sooner or later, because of recent increase in traveling to the endemic area and industrial workers originating from those areas. With this trend, we experienced a case of hydatid cyst of the liver in a male patient from Uzbekistan. This patient was presented with anaphylactic shock combined with hydatid cyst. We successfully treated using ultrasound-guided transhepatic percutaneous drainage [termed puncture, aspiration, injection, and re-aspiration (PAIR)] of the hydatid cyst and concomitant albendazole instead of surgery. In this clinical case report, we describe all the course of the patient and recommend the PAIR as a first choice method for treatment of hepatic hydatid cyst.

Coronary Artery Bypass in Myocardial Ischemia of the Young Due to Hydatid Cyst

Cardiac hydatid cyst is an uncommon disease, especially in France. It is rarely responsible for myocardial ischemia, and even more rarely in the young. We report the clinical features and imaging of a 24-year-old Tunisian woman with hydatid cyst of the free wall of the left ventricle responsible for myocardial ischemia, associated with a hepatic hydatid cyst. Management consisted of a combination of surgery with cystopericystectomy and coronary artery bypass graft and prolonged medical treatment as for treatment of hepatic hydatid cyst. Three-year follow-up revealed no recurrence. This case illustrates two interesting points: the rare clinical presentation of cardiac hydatid cyst with a coronary syndrome in a young 24-year-old woman related to compression of the left anterior descending artery by the cyst with a need for coronary artery bypass graft after resection of the cyst, and the value of medical treatment of hydatid disease, even for cardiac localization.

Experience in diagnosis and treatment of hepatic hydatid cyst complicated with biliary and bronchial fistula

肝包虫囊肿同时合并胆管和支气管瘘是肝包虫病的严重并发症,临床上较为少见.固原市人民医院自1980年5月至2006年4月共收治16例,取得满意疗效,现报告如下. 临床资料 1.一般资料:该组16例,均发生于肝右叶顶部,其中男10例,女6例,回族9例,汉族7例,年龄25～62岁,平均51岁.12例有胸痛、刺激性剧咳.其中咳黄绿色带苦味痰9例,咳黄色粉皮样物或小子囊3例,咳清水样物2例。

Albendazole is Not Effective for Primary Treatment of Hepatic Hydatid Cysts

IntroductionIn current practice, minimal invazive interventions such as percutaneous drainage and laparoscopic surgery in adjunct treatment with benzimidazoles have been gaining acceptance in treatment of hydatid cystic disease with minimal morbidity and mortality. In this prospective study, the efficacy and validity of primary medical therapy in the treatment of hydatid cystic disease has been investigated. Patients and methodsSixty-five patients with hepatic cystic disease were treated with albendazole alone between January 2004 and June 2007. All of the patients were administrated albendazole as 10 mg kg−1 day−1 divided into two equal doses for 6 months with ultrasonography (USG), serological tests, full-blood cell count and hepatic function tests performed in 2 months intervals in the course of treatment. ResultsFifty of the patients were female and 15 were male with a mean age of 47.0±16.9 (17–80). A total number of 106 cysts were present in 65 patients. Mean cystic diameter was 5.5±3.6 (1–16). In 41 of the patients, cysts were solitary and in remaining 24 patients cysts were multiple. Mean follow-up period was 28.3±8.6 (12–42) months. The overall success rate of albendazole therapy was 18 % (12/65) in the study. ConclusionAlbendazole therapy for hepatic hydatidosis is not effective in the vast majority of patients and, therefore, should not be used as the primary therapy for patients who are surgical candidates.

Percutaneous treatment of hepatic hydatid cyst in pregnancy: long-term results

To present the long-term results of percutaneous treatment of hepatic hydatid cyst in pregnancy. Six pregnant patients (age range 19-28 years; mean age 23 years) with six hepatic hydatid cysts underwent percutaneous treatment without albendazole prophylaxis. Puncture, aspiration, injection and reaspiration (PAIR technique) were used to treat the cysts. Hypertonic saline solution was used as cytotoxic agent. Follow-up was mainly by sonography every 2 weeks during pregnancy, every third month post-partum for the first year, every 6 months for the second year, and once a year thereafter. The mean follow-up time was 57.5 months. Before the treatment, average hydatid cyst volume was 2,145 ml that was reduced to 145 ml post-treatment at the time of delivery. The first five cases of the study had solid appearance of the cyst remnant (indicating complete cure) in 22 months. Cystobiliary fistula was suspected in the sixth case three months after delivery. After confirmation of the cystobiliary fistula with cystography, a percutaneous catheter was placed into the postresidual cavity and a nasobiliary catheter was placed into the common bile duct after syphincterotomy. The fistula was closed in 2 weeks. This patient has a follow-up time of 1 year so far without any problem. No mortality, morbidity, fetal loss, abdominal dissemination, or tract seeding was observed among our cases. Percutanous treatment of hydatid cysts in pregnancy is an efficient and safe procedure in cases where percutaneous treatment is indicated.

Surgical Techniques and Treatment for Hepatic Hydatid Cysts

Hepatic hydatid cysts (HHCs) are a parasitic infestation caused by several species of Echinococcus. We examined the clinical features of HHCs and evaluated the results of various surgical procedures. One hundred and sixty-nine patients aged between 17 and 84 years underwent surgery for HHCs within a 12-year period. We recorded the demographic data, location of the cysts, surgical procedures used, morbidity, recurrences, and hospital stay. Most (90.5%) of the patients presented with symptoms, but 16 (9.5%) patients reported no symptoms. The most common symptom was abdominal pain. The overall number of cysts was 216 HHCs and 9 concomitant hydatid cysts in other abdominal organs. The surgical treatments consisted of hepatic resection in 8 (4.7%) patients, cystostomy with drainage in 43 (25.5%), cystostomy with capitonnage in 22 (13%), cystostomy with omentoplasty in 72 (42.6%), and cystectomy in 24 (14.2%). Splenectomy or nephrectomy was also performed in nine patients. Postoperative complications developed in 36 (21.3%) patients, and three suffered recurrences. The postoperative mortality rate was 1.2%. Postoperative complications were more frequent after cystostomy with capitonnage than after cystostomy with omentoplasty (P < 0.001) or cystectomy (P = 0.0037). The additional procedures prolonged the hospital stay. Current surgical techniques combined with antiscolicidal therapy using albendazole are effective and safe treatments for HHCs, associated with low morbidity, mortality, and recurrence rates.

Management of Hepatic and Intracardiac Echinococcal Cysts: Case Report and Review of the Literature

Infection with Echinococcus granulosus affects the liver commonly, but disseminated involvement is rare. We describe a 63 year-old man with echinococcal infection producing both hepatic and cardiac involvement that was managed surgically after failed percutaneous hepatic treatment. This report is a case study of a unique surgical problem. Various treatment modalities are reviewed. The patient was a 63 year-old man from Iraq who immigrated to the United States after becoming infected with Echinococcus granulosus. He had undergone percutaneous management and albendazole therapy prior to presentation for treatment of hepatic hydatid cysts. He continued to have abdominal pain and fever and was referred to our institution. Imaging revealed persistence of the hepatic hydatid cysts, as well as a new finding of an intracardiac hydatid cyst. The patient underwent successful treatment of his complicated hepatic hydatid cysts with pericystectomy and repair of a biliary fistula. The cardiac cyst was removed as well. The patient made an uneventful recovery, and his symptoms resolved. Although rare, echinococcal infection may be encountered in the United States as travel increases to and from regions of the world where the disease is endemic. It is important for surgeons to be familiar with the multiple options for treatment of hydatid disease.

Sedation for percutaneous treatment of hepatic hydatid cyst in a pregnant patient

A 15 cm hepatic hydatid cyst was diagnosed in a multigravida in 16 weeks of pregnancy and was managed percutaneously under sedation. No complication occurred and she gave birth to a healthy male baby after 37 weeks gestation.

Surgical Treatment of Liver Echinococcosis — the Role of Laparoscopy

Background: The surgical approach to liver echinococcosis is still a controversial issue. This study shows our results of surgical treatment of liver hydatid cysts during a 5-year period.Methods: A prospective study of 21 patients operated on in a 5-year period (1999–2003), in Dubrava University Hospital in Zagreb, Croatia, with hepatic hydatid cyst. All patients were pre-operatively treated with albendazole. In 12 patients, total pericystectomy without opening the cyst cavity was performed, 9 open and 3 laparoscopic. In the other 9 patients, partial pericystectomy was done, 6 open and 3 laparoscopic.Results: There was no mortality after 5–65 months follow-up, but in 1 patient, in the open partial pericystectomy group, recurrence of the disease occurred after 3 years. When a laparoscopic procedure was done, there were no complications or recurrence. The median operative duration for open surgery was 100.0 min (range 60.0-210.0), and for laparoscopic surgery 67.5 min (range 60.0-120.0). The median length of hospitalisation for open surgery was 8.0 days (range 7.014.0), and for laparoscopic surgery 5.0 days (range 4.0-7.0).Conclusion: Total pericystectomy without opening the cyst cavity, preceded by pre-operative albendazole therapy is the method of choice for hepatic hydatid cyst treatment. Despite the small group of patients, our first results show laparo-scopic total pericystectomy without opening the cyst cavity, in the treatment of hepatic hydatid cyst, as a good alternative to open surgery in selected patients.

Surgical treatment of hydatid cysts of the liver.

Echinococcosis is a zoonotic disease that occurs throughout the world. The purpose of this study was to assess the clinical features and results of surgical treatment of hepatic hydatid cysts. One hundred and two patients operated on between 1991 and 2002 were reviewed retrospectively. The patients' demographic data, location, number and size of cysts, type of surgical procedure performed, morbidity, recurrences and duration of hospital stay were recorded. There were 74 male and 28 female patients with ages ranging from 15 to over 60 years. The most frequent symptom was abdominal pain. From the total of 136 hepatic cysts, 54 (39.7 per cent) were managed by cystostomy and drainage, 40 (29.4 per cent) by cystostomy and capitonnage, 16 (11.8 per cent) by cystostomy and omentoplasty, 24 (17.6 per cent) by cystectomy and two (1.5 per cent) by left lateral hepatic resection. Postoperative complications were more frequent following cystostomy with omentoplasty (six of 16 patients) compared with cystectomy (none of 18) (P = 0.005). Choledochotomy increased the length of hospital stay in patients having cystostomy and drainage (P = 0.021) and in those having cystostomy with omentoplasty (P = 0.028). Two recurrences were observed. Surgery combined with medical treatment by albendazole is effective in the eradication of hepatic hydatid disease and in the prevention of local recurrence.

Diaphragm myoplasty in the prevention of complications after surgery of hydatid disease of the liver.

A variety of techniques have been used for surgical treatment of hepatic hydatid cysts. The objective of this study is to describe the technique of diaphragm myoplasty, and to present our experience in the treatment of selected patients with hydatid disease of the liver by means of this alternative surgical technique. The technique combines a diaphragm myoplasty with a wide partial cystectomy performed through a right thoracophrenotomy incision. The medical records of the patients with hydatid disease of the liver who were submitted to surgical treatment with this technique were reviewed. The clinical manifestations, laboratory examinations, operative notes, and postoperative results were analyzed. Eight consecutive patients with hepatic hydatid cyst were operated on. The cyst was located in the posterior-superior aspect of the right hepatic lobe in all patients. Five patients suffered from recurrence of a previously operated hepatic hydatid cyst, and two patients suffered from complications of their disease. There was no in-hospital mortality or morbidity. The early and late postoperative results compare favorably with the results of other investigators. The alternative surgical technique for treatment of selected patients with hepatic hydatid disease is indicated for patients with a cyst located in the posterior-superior aspect of the right hepatic lobe, especially if there is a recurrence of the disease after a previous surgery or involvement of the diaphragm and/or the intrathoracic organs. The technique provides easy and safe access to the cyst and carries most of the advantages of omentoplasty.

Sonographically guided percutaneous treatment of hepatic hydatid cysts: Long‐term results

Sonographically guided percutaneous treatment of hepatic hydatid cysts: Long‐term results

Laparoscopic treatment of hepatic hydatid cysts

Background: Because of limited experience worldwide, controversies about the laparoscopic treatment of liver hydatid cysts have not been resolved. The aim of this study was to describe the technical details of a laparoscopic method we developed in 1992 and report the initial results from an endemic area. Methods: Of the 30 consecutive patients with 33 liver hydatid cysts considered for laparoscopic treatment during a 6-year period at a university hospital in Turkey, conversion to an open procedure was required in 7 patients (23%) while 23 patients with 25 cysts were able to be treated laparoscopically. Results: By using a special trocar to suspend the cyst against the abdominal wall, laparoscopic simple drainage was performed in 16 patients (70%) and unroofing and drainage in 6 patients (26%). Pericystectomy was performed in 1 patient (4%). Complications were observed in 1 patient (4%) perioperatively and 4 patients (17%) postoperatively. Eleven patients (48%) were followed-up for a mean of 17 months (range, 3-72 months) and 1 recurrence (9%) was detected. Conclusions: This report is a very large experience with the laparoscopic treatment of liver hydatid cysts in the literature. We have established a technique yielding a comparable morbidity and recurrence rate to open series in early follow-up. We advocate that it is a safe and simple technique with potentially a decreased risk of intra-abdominal spillage compared with the other laparoscopic methods described. (Surgery 2000;128:36-40)

Sonographically guided percutaneous treatment of hepatic hydatid cysts: Long-term results

The purpose of this study was to evaluate the safety and efficacy of sonographically guided percutaneous drainage and irrigation of hepatic hydatid cysts. Sixty-one patients with 84 hepatic hydatid cysts were treated using the puncture, aspiration, injection, and reaspiration (PAIR) technique under sonographic guidance. Patients with cysts larger than 6 cm in diameter underwent PAIR followed by percutaneous drainage (PAIR-PD). The cysts were sterilized by the injection of 1 of 2 scolicidal agents, 20% hypertonic saline solution (38 patients) or 0.5% silver nitrate (23 patients). All patients underwent follow-up examinations for 1 month-6 years after aspiration. Clinical and radiologic examinations and laboratory analyses were performed every month for the first 6 months and then at 3-month intervals. Serial sonographic examinations revealed a heterogeneous echo pattern in 78 cysts (93%); a progressive decrease in diameter in 76 cysts (90%); calcification of the cyst wall, cystic contents, or both in 10 cysts (12%); and complete disappearance of 1 cyst (1%) in a patient who had been monitored for over 6 years. Five patients developed urticaria, and 6 developed fever. One patient developed a biliary fistula after the first aspiration attempt. Two patients developed infection of the cyst cavity after PAIR-PD and were successfully treated with oral antibiotics. An anaphylactic reaction developed in 2 patients and was successfully treated with antiallergenic medication. No recurrence of hydatid disease after PAIR or PAIR-PD was observed in any patient over the follow-up period of 72 months (mean, 26 +/- 27 months). Percutaneous drainage of hydatid cysts is a safe, effective, and reliable treatment. Antiallergenic medication is required before PAIR or PAIR-PD. Both sclerosing agents, hypertonic saline and silver nitrate solutions, gave excellent results.