Treatment Of Liver Hydatid Disease Research Articles

Comparative analysis of surgical management approaches for hydatid liver cysts: conventional vs. minimally invasive techniques

IntroductionHydatid liver disease is a prevalent condition in endemic areas, particularly in the Middle East and North Africa. The use of laparoscopy as a treatment option has gained popularity. However, there is still ongoing debate regarding the optimal approach for surgical management. In this study, we present our experience with the surgical treatment of hydatid liver disease comparing conventional and minimally invasive approaches, including laparoscopic and robotic options.MethodsWe conducted a retrospective review of patients who underwent surgery for hydatid liver disease at our institution. Data was collected on the patients’ clinical presentations, cyst characteristics, surgical procedures performed, intraoperative findings, and postoperative complications.ResultsA total of 98 hydatid liver cysts were surgically managed in 57 patients. The mean age of the patients was 37.2 ± 10.2 years, with 38 (66.7%) being male. Among the patients, 14 (24.6%) underwent conventional surgery (6 partial pericystectomy, 4 total pericystectomy, and 4 liver resection), 37 (64.9%) underwent laparoscopic surgery (31 partial pericystectomy, 4 total pericystectomy, and 2 liver resection), and 6 (10.5%) underwent robotic surgery (6 partial pericystectomy). There were no significant differences between the conventional surgery and minimally invasive groups in terms of patient age, gender, cyst size, or number. However, laparotomy was associated with a higher number of total pericystectomy and liver resection procedures compared to the minimally invasive approach (P = 0.010). Nonetheless, the operation time and blood loss were comparable between both groups. Perioperative complications occurred in 19 (33.3%) patients, with 16 (84%) experiencing minor issues. Bile leak occurred in 8 (14%) patients, resolving spontaneously in 5 patients. There was no significant difference (P = 0.314) in the incidence of complications between the two groups. Conventional surgery, however, was associated with a significantly longer hospital stay (P = 0.034). During follow-up, there were no cases of mortality or cyst recurrence in our cohort.ConclusionMinimally invasive approaches for hydatid liver cysts offer advantages such as shorter hospitalization and potentially quicker recovery, making them valuable treatment options when accompanied by careful patient selection and adherence to proper surgical techniques.

Multi- and single-port laparoscopic surgery in the treatment of hydatid liver disease

To compare the effectiveness of multi-port and single-port laparoscopic surgery in the treatment of hydatid cyst of the liver. There were 25 children with solitary hydatid cyst of the liver (CL-CE2) who underwent surgery in 2013-2017. Mean age was 10.1±2.05 years. There were 17 boys and 8 girls. Patients were divided into 2 groups: group 1 (multi-port laparoscopy) - 19 patients, group 2 (single-port laparoscopic surgery) - 6 patients. Duration of ultrasound-assisted laparoscopy (G11 generator) was significantly shorter in the group 1 compared with group 2 (62.2±5.4 vs. 85.3±9.7 min, p<0.05). Intraoperative complications were absent. Biliary fistula in postoperative period was observed in 1 (5.3%) patient of the group 1. External drainage was effective. Residual cavity in 6 months after laparoscopic resection was observed in 1 (16.7%) patient of the group 2. Recurrent liver echinococcosis was not recorded. Hydatid cyst (CL-CE2) of the liver is an indication for laparoscopic echinococcectomy. Multi-port laparoscopy is characterized by reduced duration of surgery and postoperative morbidity compared with single-port procedures.

Current approaches in the surgical treatment of liver hydatid disease: single center experience

BackgroundLiver hydatid disease is a common benign condition in many countries. Compared to open surgery, laparoscopic treatment can play an important role in improving the post-operative recovery, reducing the morbidity and recurrence rate of these patients.The purpose of this study is to show that the laparoscopic method is effective and safe in the treatment of liver hydatid cysts compared to open surgery, even in large cysts.MethodsAll consecutive cases surgically managed for liver hydatid cyst from 7 January 2008 and 15 January 2010 in our institution were included in this study.The surgical approach (laparoscopic or open) and operative strategy, as well as operative and prognostic outcomes, were analyzed. Cyst size, type, location, presence of biliary tract communication, radiological findings, duration of hospitalization, recurrence and postoperative morbidity were analysed and compared retrospectively.ResultsA total of 60 patients were included in the study.A total of 23 patients underwent open surgery, and 37 patients underwent laparoscopic surgery.Operation types of laparoscopic surgery were as follows: partial pericystectomy (12patients), total cystectomy(2 patients), partial pericystectomy+total cystectomy(7patients) and cystectomy(16patients).The surgical procedures chosen for open treatment of the residual cavity were partial pericystectomy and omentoplasty(17cases), total pericystectomy(3cases) and partial and total pericystectomy(3cases).Cysto-biliary communication was found in 9 patients. A total of 10 patients underwent preoperative endoscopic retrograde cholangiography, and one patient underwent postoperative endoscopic retrograde cholangiography.There was a progression of hypernatremia in 1 patient, wound infections in 3 patients, and perioperative hemorrhage in 3 patients. There were no statistically significant differences concerning age(p = 0.344), gender(p = 0.318), ASA classification(p = 0.963), Gharbi classification(p = 0.649) whereas there were significant differences related to cyst location(p = 0.040) and size(p = 0.022) in patients undergoing laparoscopic and open surgery.Postoperative temporary biliary fistulas were observed in 2 patients undergoing open surgery. Patients undergoing laparoscopic surgery had the advantages of shorter hospital stays and operation times, less blood loss, faster recovery, and lower wound infection rates. Recurrences were detected in 2.7% of patients undergoing laparoscopic surgery and 4.7% of those undergoing open procedures.ConclusionCompared to open surgery in the treatment of liver hydatid cysts, we have shown that laparoscopic method can be safely performed even in large cysts and/or cysto-biliary communication.

Current Treatment of Hydatid Liver Disease: Surgical Perspective

journal of clinical gastroenterology is part of the Juniper publishers which is devoted to publish subject-specific articles focused on the needs of individual research communities across all areas of biology and medicine.

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.

Treatment of Hydatid Liver Disease: What does the evidence say

Cystic echinococcosis is a disease of animals and humans caused by the larval stage of of Echinococcus granulosus sensu lato and has a substantial public health impact globally. The condition is considered a neglected tropical disease (NTD) and neglected zoonotic disease (NZD), and prioritized by the World Health Organization (WHO) 1.Within the last 10 years, advancements have taken place in Echinococcus biology and genetics, including the delineation of new species within E.granulosus sensu lato (s.l.)2,3 and full sequencing of E. granulosus sensustricto. 2 Consequently, researchers are now provided with new tools to better understand parasite biology and host-parasite interactions, with the goal of opening new avenues for therapy 2. Echinococcus granulosus sensu stricto (s. s.) (G1-3) is responsible for the great majority of human CE worldwide (88.48%), has the most cosmopolitan distribution and is often associated with transmission via sheep as intermediate hosts.JMS 2016; 19(1):5-11

Radiofrequency Energy in Hepatic Bed during Partial Cystectomy for Hydatid Liver Disease: Standing Out from the Usual Conservative Surgical Management.

Background. Surgical treatment of hydatid liver disease (HLD) is divided into conservative and radical procedures. While conservative techniques are easier and faster to perform, there is an emerging need to reduce their morbidity and recurrence rates. Our aim was to present and evaluate the efficiency and safety of the application of radiofrequency energy (TissueLink® and Aquamantys® systems) in hepatic bed during partial cystectomy. Materials and Methods. Eighteen consecutive patients with hydatid liver cysts were referred to our department between April 2006 and June 2014. Data about demographics, mortality, morbidity, and recurrence rate were obtained and analyzed retrospectively. Results. The mean follow-up was 38 months (range: 4–84 months). The postoperative course of most patients was uneventful. One case of recurrence was found in our series in a patient with 4 cysts in the right lobe, 3 years after initial treatment. He was reoperated on with the same method. Conclusions. Saline-linked RF energy seems to be an effective means to be employed in conservative surgical procedures of HLD, with satisfactory postoperative morbidity. Recurrence rates appear to be low, but further follow-up is needed in order to draw safer conclusions.

Radical Laparoscopic Treatment for Hepatic Hydatid Disease

Background: Surgical approach is considered the most effective treatment for hydatid liver disease (HLD). Nevertheless, there is no general consensus regarding whether either open or laparoscopic surgery is the best approach. Aim: To evaluate laparoscopic approach for the surgical treatment of HLD. Methods: A retrospective study was performed. Patients with uncomplicated HLD who underwent laparoscopic radical pericystectomy from April 2007 to May 2015 were included. Preoperative variables, cyst characteristics and recurrence rates were analysed. Results: Twenty-four patients underwent radical laparoscopic surgery. The median age was 35 years (3-79). The median sizes were 8 cm (3-15). The in-hospital stay was 3 days (2-25) and the overall morbidity was 16% (4 cases), one patient presented biliary leak complication. No mortalities were registered. The median follow-up care of this cohort was 57,5 months (9-106), one case of thoracic recurrence was observed. Conclusions: Based in our experience, treatment of uncomplicated HLD by laparoscopic pericystectomy is safe and feasible; it concluded no increase in perioperative morbidity, recurrence rate or mortality compared to previous published data.

Conventional Versus Laparoscopic Surgery for Hepatic Hydatidosis: a 6-Year Single-Center Experience

BackgroundThe aim of this study is to evaluate the clinical results of laparoscopic surgery compared with conventional surgery. MethodsRecords of patients who underwent surgery for liver hydatid disease between 2005 and 2011 were reviewed. Operative time, blood loss, conversion to open, postoperative morbidity, mortality, hospital stay, and recurrence rate were measured. ResultsAmong 353 eligible patients, 60 were considered for laparoscopic and 293 for conventional surgery. Operative time was slightly increased in laparoscopic group. No major blood loss and blood transfusion were needed. Postoperative hospital stay was significantly short in laparoscopic group (3.8±1.2 days) than that in conventional group (7.4±1.4 days). The overall morbidity was 13.3 % (8/60) in laparoscopic and 19.8 % (58/293) in conventional group without significance. Both conversion rate and mortality was 0 %. One recurrence in laparoscopic (1.7 %, 1/60) and five in conventional group (1.7 %, 5/293) occurred within 48 months of follow-up. ConclusionsLaparoscopic treatment of liver hydatid disease is safe and effective in selected patients with all its advantages.

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.

Laparoscopic treatment of liver hydatid disease

Surgical treatment has been considered the only available treatment of liver hydatid disease because of the complete removal of the parasite. According to the new standards for clinical approach to hepatic hydatid disease, there is no golden rule and the individual approach to every patient and cyst is of greatest importance. The laparoscopic method in the treatment of liver hydatid disease includes complete excision of the cyst, unroofing, evacuation and obliteration of the cyst cavity. Some authors perform a direct exploration of the cyst cavity in order to reject or confirm the presence of the communication of the cyst with the biliary tree. The laparoscopic method has advantages as a minimally invasive method with shorter hospital stay and minimal risk of wound complications. All the arguments prove the laparoscopy to be feasible and effective method of treatment of liver hydatid disease. Scripta Scientifica Medica 2013; 45(1): 17-20.

Surgical treatment of liver hydatid disease by laparotomy

The rate of deep organ space/surgical site infection after conservative surgery for hepatic cystic echinococcosis (HCE) ranges from 12% to 26% with a post-operative mortality rate between 0% and 7.5%. This systematic review with meta-analysis aimed to investigate whether omentoplasty (OP) following conservative surgery for HCE leads to decreased rates of morbidity and mortality compared to external tube drainage ETD.We identified 4540 articles through database searching. After verifying the inclusion and exclusion criteria, we retained eight studies for final analysis: two randomized controlled trials (RCT), one prospective comparative study and five retrospective comparative studies. The main outcome measure was organ space/surgical site (OS/SS) morbidity that was limited to “deep organ space/surgical site infection (Deep OS/SSI) with or without re-operation”.The eight studies reported results for deep OS/SSI (6/374 (OP) and 60/403 (ETD), respectively). There were statistically significantly less deep OS/SSI with OP (vs. ETD) OR = 0.17 95%CI [0.05, 0.62] (P = 0.007). A random-effect meta-regression, including the eight studies, showed an interaction in favor of OP. There were also statistically significant less biliary leakage ± fistula and overall morbidity in OP compared to ETD. On the other hand, no statistically significant difference was found concerning deep bleeding, mortality and recurrence between these two groups.This meta-analysis with a meta-regression showed that there were statistically significant less deep OS/SSI, biliary leakage ± fistula and overall morbidity in OP compared to ETD.

Role of albendazole in the management of hydatid cyst liver

Background/Aim:Hydatidosis has a worldwide distribution and the liver is the most common organ involved. Hydatid cysts of the liver can be managed either by nonoperative or operative methods. Nonoperative methods include chemotherapy and percutaneous treatment. The study aimed at understanding the effect of albendazole therapy on the viability of protoscoleces and recurrence rate of hydatid disease of the liver.Patients and Methods:The study was conducted at Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India, over a period of 2 years from January 2002 to December 2003, with further follow-up of 5 years. The study included 72 cases in the age group of 17-66 years, comprising 39 males and 33 females. The patients were randomized into two groups of 36 patients each. In group A, patients were directly subjected to surgery, while in group B, patients were administered albendazole for 12 weeks preoperatively, followed by a further postoperative course for 12 weeks.Results:Of patients who received albendazole therapy, no patient had viable cysts at the time of surgery, as compared to 94.45% of the patients who did not receive any preoperative albendazole (P<0.01). In patients who did not receive any albendazole therapy, recurrence rate was 16.66%, while no recurrence was seen in patients who received albendazole therapy (P≤0.05).Conclusion:We conclude that albendazole is an effective adjuvant therapy in the treatment of hydatid liver disease.

Surgical treatment of hydatid disease of the liver: 25 years of experience

Background The aim of this study was to evaluate the results of conservative and radical treatment of liver hydatid disease. Methods Records of patients who underwent surgery for liver hydatid disease between 1980 and 2005 were reviewed. Outcomes measured were operative morbidity and mortality, hospital stay, and recurrence. Results Two hundred fourteen patients underwent conservative treatment (external drainage, marsupialization, omentoplasty), and 240 had radical surgery (hepatic resection, cystopericystectomy). Operative morbidity was 79.9% and 16.2% for conservative and radical procedures, respectively ( P < .001). Operative mortality was 6.5% for conservative procedures and 9.2% for radical procedures ( P = .3). The recurrence rate was 30.4% in patients having conservative surgery and 1.2% in patients undergoing radical surgery ( P < .001). No recurrences occurred in patients with clear cysts after conservative surgery. Conclusions Cystopericystectomy was a safe and effective procedure that achieved excellent immediate and long-term results. Hepatic resection should be considered only in exceptional cases, because it involves the unnecessary sacrifice of healthy hepatic parenchyma. Conservative surgery and alternative procedures should be restricted to the treatment of clear cysts and to patients who cannot undergo radical surgery.

Albendazole as an adjuvant to the standard surgical management of hydatid cyst liver

Background The treatment options for hydatid cyst liver include non-operative and operative methods. Operative methods include conservative and radical procedures. Non-operative methods include chemotherapy and percutaneous treatment of liver hydatidosis. Material and methods The study was conducted at Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India, over a period of two years from March 2001 to February 2003 with further follow-up of 5–6 years. The study included 64 cases in the age group of 15 years to 64 years, comprising 36 males and 28 females. The aim of the study was to know the effect of preoperative and postoperative albendazole therapy on the viability of protoscolices and recurrence rate of hydatid disease of liver. Patients were divided into four group of 16 each. In group A, patients were directly subjected to surgery. In group B, patients were given albendazole for 8 weeks followed by surgery. In group C, patients were given albendazole for 8 weeks preoperatively followed by further postoperative course for 8 weeks. In group D, patients were first taken for surgery followed by postoperative course of albendazole for 8 weeks. Results Out of those patients who received preoperative albendazole only 9.37% had viable cysts at the time of surgery as compared to 96.87% of patients who did not receive any preoperative albendazole. In those patients who did not receive any albendazole therapy, recurrence rate was 18.75% whereas recurrence was 4.16% in patients who received albendazole therapy. Conclusion We conclude that albendazole is safe and effective adjuvant therapy in the treatment of hydatid liver disease.

Treatment of Hydatid Liver Disease

Echinococcal disease is still a serious problem in certain parts of the world. The liver is the organ affected most frequently. Over recent decades, various reports have been published comparing standard surgical and more conservative modalities for the treatment of the disease. Proper selection among the strategies reported so far could be the most appropriate part of successful patient management. A thorough review of the most recent reports on the treatment of liver Echinococcus infection, including percutaneous drainage, medical management, and laparoscopic, endoscopic and open surgical approaches has been conducted, focusing on patient outcomes. The standard surgical approach, namely partial capsectomy, drainage, and epiploplasty, remains the most frequent operative method. Previous problems such as disease recurrence and a residual cavity seem to be managed optimally with more radical operations such as total pericystectomy. Laparoscopic and endoscopic approaches (endoscopic retrograde cholangiopancreatography and sphincterotomy) appear to have a crucial role, especially when the location of the cyst or the patient's status does not permit more radical approaches. Percutaneous computed tomography- or ultrasound-guided drainage appears to be of great value in certain cases. Chemotherapeutic agents remain useful as an adjuvant treatment. Appropriate patient selection and proper use of the various available treatments are of great importance. A tailor-made approach should be employed for each patient. The surgeon's experience constitutes a principal criterion. To achieve the best possible results, an interdisciplinary approach should be used in the majority of patients.

Long-term Results of Surgical Treatment of Hydatid Disease

Background-Aims: non-radical surgery is the preferred method of treatment of hydatid liver disease, and is associated with low mortality and recurrence rate. The purpose of the study is the retrospective analysis of the outcome of patients who were treated surgically in a single institution.Material and methods: between 1987 and 2005, 59 patients, mean age 58.2 ± 15.9 (13–83) years, underwent surgery for liver hydatid disease. The patients were reassessed with physical examination, serological tests and radiological examination for the evaluation of the recurrence rate.Results: most cysts were solitary, the more frequently affecting the right lobe of the liver. Radical surgery was possible in four cases (6.8%) that were classified as PNM stage I. Partial cystectomy and omentoplasty was performed in 37 patients (62.7%) and external drainage with partial cystectomy in 18 patients (30.5%). The hospital morbidity was 27.2% and was found to be related to ASA class (p = 0.019). Hospital mortality was 5.1%. The median follow-up time was 94 (1–228) months and 45 out of 59 patients (76.3%) were reassessed, but no recurrence was recorded. There was no significant difference in morbidity, mortality, and hospital stay between partial cystectomy combined with external drainage or omentoplasty (p > 0.05).Conclusions: PNM staging seems to be a reliable tool in selecting patients with liver hydatid disease for non-radical or radical surgery. Omentoplasty is an easy and effective surgical method for the treatment of hepatic echinococcosis but is not different than partial cystectomy and external drainage in regard to morbidity, mortality, and recurrence.

Ivermectin used in percutaneous drug injection method for the treatment of liver hydatid disease in sheep

Ivermectin is a macrocyclic lactone (avermectins) produced by the actinomycete Streptomyces avermitilis. In this experimental study, the effectiveness of intracystic injection of ivermectin was studied as a new approach of percutaneous treatment of cystic echinococcosis. Twelve naturally infected sheep were selected and divided into 2 subgroups: treatment group (n = 9) and control group (n = 3). In the treatment group, approximate volume of ivermectin solution needed to achieve an intracystic concentration of 10 microg/mL was injected into cysts, but in the control group, sterile distillated water was applied. No reaspiration was performed at all. In the following period of 6 months, repeated sonography revealed a significant decrease in cyst sizes and progressive solidification of the cysts in the treatment group. In the control group, volumes of the cysts were increased. No major complications occurred during or after the procedure. After 6 months, all sheep were killed and examined for macroscopic and microscopic changes. Pathologic examination in the treatment group showed pericyst hyalinization, inflammatory cells in the cyst wall, degeneration of laminated and germinal membrane, and necrotic material in the cyst cavity. No viable protoscolices or daughter cysts were observed. Percutaneous treatment of cystic echinococcosis with ivermectin as a scolicidal agent seems to be effective in this animal model.

Albendazole Therapy in the Treatment of Hydatid Liver Disease

Hydatid disease, a common health problem in Turkey as in many countries, should be included in the differential diagnosis of all patients presenting with a cystic mass in the abdominal or thoracic cavity. Previously, surgery had been the main form of treatment. But with the introduction of preoperative medication with albendazole, treating this disease medically is now growing in popularity. We report herein the findings of ten patients with two lung and 20 liver hydatid cysts ranging from 3 to 20 cm in diameter, who were successfully treated with medical therapy. Multiple organ involvement and multiple cysts in an organ are the main indications for medical treatment with albendazole, but the indications should not be limited to certain situations such as small-sized cysts, since even huge-sized cysts responded well to the therapy in this series.