Unroofing Of Cyst Research Articles

Sleeve Gastrectomy And Liver Cyst Unroofing In Morbid Obesity With Multiple Liver Cysts: A Case Report

Background: Obesity has become a major global health issue which leads to various complications, including hepatic diseases. However, we found a rare case of morbid obesity and symptomatic multiple liver cysts. Aim: This article aims to represent a rare case of morbid obesity and multiple liver cysts surgically managed by sleeve gastrectomy and liver cyst unroofing which were performed in a single surgery. Case report: 41-year-old female presented with morbid obesity and blunt intermittent abdominal pain in the right upper quadrant. Stage II hypertension, tenderness on the right upper quadrant of the abdomen and epigastrium were found in clinical assessment. Lipid profiles were shown to be elevated. Abdominal CT revealed fatty liver and multiple cystic lesions in all hepatic segments. Discussion: Non-parasitic liver cysts affect 2-18% of the global population, with a higher prevalence in females possibly due to hormonal factors. Obesity is associated with hormonal alterations, potentially leading to increased secretion of FSH and LH. Conclusion: Sleeve gastrectomy and liver cyst unroofing may be considered as a treatment strategy for patients with morbid obesity and multiple liver cysts.

Successful Kidney Transplantation Using Elderly Living Donor with Extremely Large Renal Cyst and Double Arteries.

The authors describe a kidney transplant procedure using a living donor with a large cyst and double arteries. Due to the lack of regular transplant activity from a deceased donors, we decided to use the, so called, expanded criteria living donors, which means older age (more than 65 years), hypertension, some structural anomalies of the kidneys (cysts, multiple renal arteries), ABO incompatible kidney transplant, etc. The surgical procedure was the unroofing of a large cyst and wadding with perirenal fat. The 10 years survival rate is quite successful and we can recommend it.

Watchful waiting for large primary nonparasitic splenic cysts.

Primary nonparasitic splenic cysts (NPSC) are typically diagnosed incidentally. The management of large (≥ 5 cm) asymptomatic cysts remains controversial; there is a lack of evidence guiding management. The purpose of this study was to describe the outcomes of nonoperative management of large NPSC. Patients diagnosed with NPSC between January 2004 and December 2019 were identified at our academic institution. Adult patients with an NPSC of at least 5 cm who had at least 1 additional hospital visit were included. Data are presented as medians with interquartile ranges (IQR). We identified 512 medical records that included the term splenic cyst during the study period. Sixty-eight of the patients had no reported cyst size, 410 had cysts smaller than 5 cm, 1 patient underwent an elective splenectomy at another institution and 12 patients were excluded for other reasons; 21 patients with cysts of at least 5 cm were included in the study. Eight symptomatic patients underwent surgery at our institution. Of these, 2 presented acutely: 1 with hemoperitoneum who required admission for transfusions and later underwent elective laparoscopic splenectomy and 1 with increasingly severe abdominal pain who underwent laparoscopic cyst unroofing. The remaining 6 symptomatic patients had elective surgery for pain (4 cyst unroofing, 1 total splenectomy, 1 partial splenectomy). Thirteen patients were asymptomatic (10 female, median age 49.2 [IQR 38.1 to 64.6] yr). Two of these patients chose to undergo elective surgery. The remaining 11 asymptomatic patients, with a median initial cyst size of 8.0 (IQR 5.3 to 10.8) cm, were followed for a median of 31.0 (IQR 23.5 to 71.0) months. There was no change in median cyst size (0 [IQR -1 to 0] cm), and none of these patients underwent intervention for their NPSC. Asymptomatic patients managed nonoperatively for large NPSC did not become symptomatic or require intervention during the study period. This supports watchful waiting with serial radiologic and clinical monitoring for asymptomatic large NPSC.

Unroofing of Lower Pole Native Kidney Cysts in Patients with Autosomal Dominant Polycystic Kidneys at the Time of Kidney Transplantation.

To report our experience with unroofing of ipsilateral lower pole kidney cysts in five patients with adult-type polycystic kidneys [ADPKD] when free implantation of kidney allograft interfered with lower pole native kidney cysts. In all of these patients, the native kidneys extended to the ipsilateral pelvis and bilateral ADPKD caused enlargement of the abdomen on gross examination. Unroofing of lower pole kidney cysts was performed during the same session of allograft transplantation. The decision to unroof lower pole cysts of the ipsilateral kidney was made after observing interference of lower pole cysts with free implantation of the allograft. In patient A, bilateral native nephrectomy was performed 6 weeks after kidney transplantation after consultation with the patient, when there was evidence of the good function of the allograft and the recipient was on a low dose of immunosuppressive medications. In other patients, no need for native nephrectomy observed. This experience suggests the possibility that when large ipsilateral kidney cysts interfere with safe implantation of the allograft, there is an option of performing cyst unroofing at the same session and proceeding with allograft implantation. In many patients, there would be no need for native nephrectomy and of deemed necessary, it will be performed later, when there is evidence of the good function of the allograft and the patient is on good kidney function with a low dose of immunosuppressive medications and a less risk profile for the operation. To our best knowledge, there is no prior such report in the literature.

Prolonged postoperative urine leakage due to a calyceal diverticulum mimicking a renal cyst: A case report and literature review

BackgroundThe calyceal diverticulum is a rare cystic cavity that communicates with the collecting system via a narrow neck or infundibulum. In clinical practice, part of the calyceal diverticula is difficult to differentiate from simple renal cysts even after contrast-enhanced CT. To date, there have been few kinds of literature works on the diagnosis and treatment of calyceal diverticulum combined with renal pelvis dilatation, especially concerning the treatment of prolonged postoperative urine leakage.Case descriptionA 53-year-old woman with calyceal diverticulum and renal pelvis dilatation mimicking a simple renal cyst suffered urine leakage after receiving laparoscopic unroofing of the renal cyst. A persistent urine leakage was observed immediately after surgery, with about 200 ml of drainage fluid per day. We first attempted to place a double-J ureteral stent and indwell a catheter. After failing that, conservative treatment was performed. The core idea of the conservative treatment is retaining the drainage tube for more than 1 month, then clamping the drainage tube for 1 week, and finally removing the drainage tube. By 3 weeks of follow-up, the urine leakage disappeared, and the CT scan showed hydronephrosis of the right kidney without perirenal exudation and the lower pole cyst of the right kidney shrank significantly.ConclusionThis case, we reported here, is to attract the attention of clinicians. Renal cysts should exclude the possibility of the calyceal diverticulum. If urine leakage is inevitable after surgical treatment, our conservative treatment strategy is also an alternative method.

Does the Simple Renal Cyst Treatment Improve Renal Function: A Pilot Study.

Background:The current study aims to assess the effects of the large simple renal cyst (SRC) surgery on renal function for the first time.Materials and Methods:This case-series study included 22 patients with larger than 50 mm single SRC who underwent laparoscopic cyst unroofing surgery. Twenty-four-hour urinary protein, creatinine, and volume along with plasma creatinine and estimated glomerular filtration rate (GFR) were measured in patients before and 1 month after surgery. Patients underwent abdominopelvic computed tomography-scan without contrast and parenchymal thickness diameter adjacent to the cyst was measured before and after surgery.Results:Mean age and weight of patients were 52.2 ± 8.9 years and 77 ± 10.9 akg, respectively. There was no significant difference between plasma creatinine and GFR before and after surgery (P = 0.25 and 0.37, respectively). Twenty-four-hour urinary volume, creatinine, and protein before and after surgery revealed no significant changes (P = 0.37, 0.08, and 0.31, respectively). The mean improvement of parenchymal thickness diameter after surgery was 10.4 ± 0.7 mm which was statistically significant (P = 0.001). However, it was not correlated with the mean estimated GFR change (r = 0.349, P = 0.13).Conclusions:Although laparoscopic unroofing of renal cyst recovered renal parenchymal thickness noticeably, it did not improve renal function significantly; therefore, the latter factor lonely should not be considered a reason for surgery decision. Observation can be chosen as a safe treatment strategy in large SRCs without concern about renal function.

Treatment of multiple huge liver cysts in a hybrid operating room: a case report

BackgroundLiver cysts are common, with most cases being asymptomatic. In symptomatic cases, the disease is amenable to treatment. However, huge or multiple liver cysts with vascular narrowing and associated systemic symptoms are extremely rare. Furthermore, the performance of a reliable and effective surgery in such cases remains a major problem. Here, we report a case of multiple giant liver cysts with impaired blood flow surgically treated in a hybrid operating room.Case presentationA 73-year-old male presented to a previous doctor with leg edema and dyspnea on exertion; computed tomography revealed that the cause complaint was right lung and heart compression and inferior vena cava (IVC) stenosis due to huge liver cysts in the caudal lobe. The patient was referred to our hospital because of disease recurrence despite percutaneous aspiration of the cyst. Multiple liver cysts were observed in addition to the drained cysts, two of which were located on both sides of the IVC and caused IVC stenosis. We performed open surgery for the liver cysts and used the hybrid operating room for intraoperative IVC angiography and measuring the hepatic vein and portal vein (PV) pressure. We performed unroofing of the hepatic cyst and cauterization of the cyst wall on the hepatic side. Angiography was performed before and after unroofing of the liver cysts, and IVC stenosis release was confirmed. IVC pressure measured at the peripheral side of the stenosis and PV pressures were continuously measured during surgery and were confirmed to have decreased during the opening of the liver cysts. The patient had a good postoperative course and was discharged on the 10th postoperative day. No recurrence was observed 6 months postoperatively.ConclusionsCyst unroofing surgery using angiography in a hybrid operating room is a useful treatment for deep hepatic lesions in that vascular stenosis improvement can be intraoperatively confirmed. Moreover, in cases wherein the cyst compresses the vasculature, intraoperative monitoring of IVC and PV pressures can be used to prove that the liver cyst is hemodynamically involved.

Robotic single port (plus one) unroofing of multiple liver cysts using the DaVinci SP system

Unroofing or marsupialization of liver cyst is performed for symptomatic case or growing cysts. Laparoscopic approach is widely used but few reports describe robotic approach for this procedure. Nowadays, single-port robotic surgery is adopted for various surgical procedures. We present a case of robotic single port (plus one) unroofing of multiple liver cysts using the DaVinci SP system. A 53-year-old female was referred for multiple liver cysts which were diagnosed 6 years ago. Albeit asymptomatic, surgical resection was decided for enlarging cysts and subsequent pancreatic duct dilatation. Robotic port was inserted through transumbilical incision and an additional 5-mm-port was placed on the left side of the DaVinci SP system for energy device and suction/irrigation. Unroofing was done for most cysts and a drain was placed through the additional port. The operation time was 90 minutes, including 2 minutes of docking time and 57 minutes of console time, with negligible intraoperative blood loss. The drain was removed on the fifth postoperative day and the patient discharged on the ninth postoperative day without acute complication. Postoperative CT scan 3 months later confirmed decreased size of liver cysts and no evidence of pancreatic duct dilatation. We report our experience of robotic single port (plus one) unroofing of multiple liver cysts using the DaVinci SP system. To our knowledge, this is the first report in Korea using the DaVinci SP system for unroofing of liver cyst. We believe that this approach is superior to laparoscopic approach while achieving similar safety outcome with fewer incisions.

Robotic Unroofing of Large Hepatic Cyst: A Definitive Surgical Solution With Minimally Invasive Technique.

Robotic Unroofing of Large Hepatic Cyst: A Definitive Surgical Solution With Minimally Invasive Technique.

A comparative study of mini- versus standard laparoscopy in the treatment of renal cysts

Introduction This study aimed to investigate the safety and efficacy of mini-laparoscopy for renal cyst unroofing. Material and methods Eighty-six patients for treatment of renal cysts that met the selection criteria were included in this study. They were divided into two groups. Forty-five patients underwent cyst unroofing via mini-laparoscopy (Group M), and 43 patients underwent cyst unroofing via standard laparoscopy (Group S). There were no differences between the two groups in terms of sex, age, body mass index or clinical data. Data from the groups were recorded and analyzed. Results The average hospital stays were shorter (p = .039) and postoperative painkiller demand was lower (p = .031) in Group M than in Group S. Forty-one out of 45 procedures in Group M were successful, and all 43 cases in Group S were successfully. With a follow-up period of 0.5 to 5.5 years, there was no significant difference in recovery rate (p = .213). Questionnaires showed that patients in Group M were significantly more satisfied with their cosmetic results than were patients in Group S (p = .041). Conclusion Our findings suggest that renal cyst decortications with mini-laparoscopic instruments are as safe and effective as procedures using standard laparoscopic instruments. Cosmetically, the results are better with mini-laparoscopy than with standard laparoscopic unroofing.

Single-Port Percutaneous Nephroscopy combined with GreenLight Laser in Simple Renal Cyst.

Objective:To explore the therapeutic effect of percutaneous nephroscopy combined with Green Light laser on simple renal cyst.Methods:A retrospective analysis was conducted to review the clinical data, surgical procedures, intraoperative bleeding, postoperative adverse reactions, and length of stay of 32 patients who had been admitted to Affiliated Hospital of Hebei University from January 2018 to February 2019. All patients had been diagnosed with simple renal cyst by imaging examination and met the surgical indications for single-port percutaneous nephroscopy combined with GreenLight laser for unroofing and decompression of the renal cyst. Among the 32 patients, there were 18 males and 14 females, with 15 cases on the left and 17 on the right. The patients aged 38 to 62 years old, with an average of 45 years old. Thirteen cases were hospitalized mainly due to complaint of lumbar pain, and 19 cases were admitted after a renal cyst was found by physical examination. The diameter of the cyst ranged from 4.2 to 9.1 cm, with an average of 6.1 cm. A percutaneous nephroscopic channel was established during the surgery. Once a nephroscope was placed into the cyst, GreenLight laser (energy of 80W) was used to remove the free cyst wall 0.3cm from the renal parenchymal margin under direct vision. After the incision margin was observed with no obvious exudation under microscope, the cyst wall was removed through the channel and sent for pathological examination. A drainage catheter was placed near the cyst cavity.Results:All the 32 patients were successfully operated, without transition to laparoscopic and open surgery. The operations took 30 to 62 minutes, with an average of 45 minutes. The intraoperative bleeding ranged from three to 14 ml, with an average of 10 ml. No adverse events such as postoperative infection, fever, or active bleeding occurred. The drainage catheters were removed one to three days after operation, with an average of 1.5 days after operation. The drainage volume was 20 to 55 ml, with an average of 35 ml. No obvious liquid extravasation was seen in all cases. The length of stay after operation ranged from three to five days, with an average of 3.5 days. Postoperative pathological reports all suggested renal cyst wall. The patients were followed up for six months, and no cyst recurred.Conclusions:Single-port percutaneous nephroscopy combined with Green Light laser could provide significant clinical effect in treating simple renal cyst with minimal trauma.

Laparoscopic left hepatectomy for mucinous cystic neoplasm of the liver

Among liver cystic lesions, mucinous cystic neoplasm of the liver (MCN-L) constitutes a challenging issue in terms of management: preoperative diagnosis is often unachievable and this may mislead to inappropriate treatment [1–3]. We present the case of an otherwise healthy 29-year-old female who underwent laparotomic cyst unroofing in segment 4 and cholecystectomy in another institution. Post-operative course was complicated by biliary leakage that was endoscopically treated. Short term follow-up showed early recurrence with a volumetric enlargement of the cyst occupying most of the left hepatic lobe and new satellite cyst in Sg5. The doubt of MCN-L arose, and the patient was scheduled for laparoscopic removal at our Centre, despite the previous laparotomic procedure. An optic port was placed into right upper abdominal quadrant and 3 further ports were placed. A long and difficult adhesiolysis was performed and Pringle’s manoeuver was settled. Intraoperative US confirmed the anatomic limits of the cysts in Sg5 and in the left hepatic lobe. The cyst on Sg5 was resected first and frozen section was suspicious for MCN-L. In order to prevent recurrence, left laparoscopic hepatectomy was performed. The specimen was extracted through the previous midline laparotomy. Post-operative course was uneventful and the patient was discharged on POD 5. Pathology and immunochemistry confirmed the diagnosis of MCN-L. Hepatic cystic lesions may be insidious and preoperative biopsy is not always possible due to lack of solid tissue. In unclear settings, an intraoperative frozen section is mandatory to guide intraoperative decisions. In the suspicion of malignancy, resection with oncologic criteria must be chosen as the most appropriate treatment, as well as the retrieving of MCN-L requires hepatic resection to avoid early recurrence [4, 5]. Despite of previous laparotomy, we consider a laparoscopic approach could be attempted in selected cases, in institution with particular expertise in laparoscopic liver surgery.

AB030. The application of plasma column electrode in delayed bleeding after PCNL and unroofing of renal cyst

BackgroundTo observe the clinical effect of plasma column electrode in the treatment of delayed bleeding after PCNL and simple renal cyst.MethodsFrom March 2011 to September 2017, we retrospectively analyzed the clinical data of 9 cases with delayed bleeding after PCNL and 17 cases with simple renal cyst. The plasma column electrode was adopted to stop bleeding and to resect the cyst wall.ResultsPatients with delayed bleeding after PCNL were successfully stanched by using plasma column electrode; The renal cyst was successfully removed and decompressed by plasma column electrode through percutaneous ureteroscopic deroofing of renal cyst.ConclusionsThe plasma column electrode has the advantages of accurate, safe, simple and small trauma in the treatment of delayed bleeding after PCNL and simple renal cyst. It is suitable for popularization and use.

Laparoscopic liver surgery: towards a day-case management.

Ambulatory surgery (AS) is a contemporary subject of interest. The feasibility and safety of AS for solid abdominal organs are still dubious. In the present study, we aimed at defining potential surgical criteria for AS by analyzing a large database of patients who underwent laparoscopic liver surgery (LLS) in two French expert centers. This study was performed using prospectively filled databases including patients that underwent pure LLS between 1998 and 2015. Patients whose perioperative medical characteristics (ASA score<3, no associated extra-hepatic procedure, surgical duration≤180min, blood loss≤300mL, no intraoperative anesthesiological or surgical complication, no postoperative drainage) were potentially adapted for ambulatory LLS were included in the analysis. In order to determine the risk factors for postoperative complications, multivariate analysis was carried out. During the study period, pure LLS was performed in 994 patients. After preoperative and intraoperative characteristics screening, 174 (17.5%) patients were considered for the final analysis. Lesions (benign (46%) and liver metastases (43%)) were predominantly single with a mean size of 37±32mm in an underlying normal or steatotic liver parenchyma (94.8%). The vast majority of LLS performed were single procedures including wedge resections and liver cyst unroofing or left lateral sectionectomies (74%). The global morbidity rate was 14% and six patients presented a major complication (Dindo-Clavien≥III). The mean length of stay was 5±4days. Multivariate analysis showed that major hepatectomy [OR 29.04 (2.26-37.19); P=0.01] and resection of tumors localized in central segments [OR 41.24 (1.08-156.47); P=0.04] were independent predictors of postoperative morbidity. In experienced teams, approximately 7% of highly selected patients requiring laparoscopic hepatic surgery (wedge resection, liver cyst unroofing, or left lateral sectionectomy) could benefit from ambulatory surgery management.

Early Experience in Starting a Laparoscopic Liver Resection Program in Greece.

Background and Objectives:Laparoscopic liver resections (LLRs) have gained wider acceptance during the decade as safe and efficient procedures in the management of several benign and malignant diseases when performed by experienced surgeons. We report our initial institutional experience with LLRs performed by 1 certified hepatobiliary surgeon.Methods:Patients undergoing LLRs by 1 senior hepatobiliary surgeon in our Institution during the period from January 2012 through January 2017 were prospectively sampled and retrospectively analyzed for the purposes of this study.Results:Forty-two of 175 patients (24%) who had surgery for liver tumors underwent LLR. Median age was 64 years; median body mass index and Charlson comorbidity index were 27.3 kg/m2 and 6.5, respectively. Patients underwent resections for benign (n = 22) or malignant (n = 20) lesions. Median total operating time was 115 minutes and liver resections included: 1 left hepatectomy, 11 bisegmentectomies, 7 segmentectomies, 5 wide wedge resections, 1 left lateral sectionectomy combined with segmentectomy and radiofrequency ablation, 15 liver cyst unroofing, 1 laparoscopic drainage of a pyogenic liver abscess, and 1 laparoscopic drainage of a hepatic hydatid cyst. Blood transfusion was needed in 10 patients. Six patients (14%) had postoperative complications, none of which necessitated reoperation. None of the patients was admitted to the intensive care unit after surgery, and the median hospital stay was 4 days. The tumor-free resection margin was documented in all primary or secondary oncologic cases.Conclusions:Careful patient selection and compliance with the international recommendations are the keys for the successful introduction and evolution of an LLR program with a certified hepatobiliary surgeon with laparoscopic experience.

Transmesentric laparoscopic unroofing of left simple renal cyst: a report of 12 cases

Objective To investigate the method and efficacy of transmesentric laparoscopic unroofing of the left simple renal cyst. Methods The clinical data of 12 patients(4 males, 8 females) with left renal simple cyst treated by transmesentric laparoscopic unroofing were retrospectively analyzed.The mean age was 55 years(ranged 32~72). The mean diameter of the cases was 6.2 cm(ranged 4.8~8.6 cm). All the renal cysts were indicated by ultrosonography, CT scan and IVP.For each patient, the body mass index(BMI), blood loss, operative time, time to resumption of oral intake and complications, postoperative hospitalization days were recorded. Results All 27 cases of transemensetic laparoscopic unroofing renal cyst were successfully performed, without conversion to open surgery or serious intraoperative complications.Mean operative time was (36.3±11.6)min, and blood loss was (14.6±5.3)mL.The mean time of ambulation was 12h, and time of oral intake was 16h.The mean postoperative hospitalization time was (3.89±2.13)d.All the cases were assessed with ultrosonography and CT scan, no renal cyst recurrence was found during the follow-up of 3 months to 5 years. Conclusion Transmesentric laparoscopic unroofing of left simple renal cyst is a new and effective technique, which enables a shorter operation time without increasing morbidity, especially for slim patients. Key words: Laparoscopy; Cysts; Kidney

Natural history of hematospermia in 189 Japanese men.

To prospectively investigate the natural history of hematospermia. This study included 189 patients with hematospermia. All the patients underwent watchful waiting without any empirical treatment. The median observation period was 52 months. Hematospermia resolved spontaneously in 168 (88.9%) of the 189 patients, and the median disease duration was 1.5 months. Kaplan-Meier analysis showed that the persistence rates of hematospermia were 57.7% at 1 month, 34.2% at 3 months, 23.3% at 6 months, 12.5% at 1 year and 7.6% at 2 years. Hematospermia reoccurred in 20 (13.5%) of the 148 patients who had adequate follow up. The recurrence-free rates were 96.6% at 3 months, 89.0% at 1 year, 84.8% at 5 years and 78.2% at 10 years. Multivariate analysis showed that seminal vesicle hemorrhage and a midline cyst of the prostate were significant factors to predict the duration of hematospermia until spontaneous resolution. The nine patients with persisting hematospermia for more than 1 year were treated with transurethral endoscopic surgery (unroofing of the midline cyst in six, and transurethral resection of the ejaculatory duct in three), and hematospermia resolved postoperatively in all these patients. In patients with hematospermia without inflammation, infection or malignancy, it is important to provide information on the possibility that symptoms will resolve spontaneously and to implement measures to relieve their anxiety. Detection of seminal vesicle hemorrhage and a midline cyst of the prostate is important for prediction of the duration of hematospermia.

Transperitoneal laparoscopic parapelvic cyst unroofing of 45 cases

Objectives To evaluate the experience and clinical efficacy of transperitoneal laparoscopic parapelvic cyst unroofing. Methods From 2008 to 2015, 45 cases of transperitoneal laparoscopic parapelvic cyst unroofing were collected. Of all the cases, 33 males and 12 females, aged from 35 to 65 years, and 27 patients in left, 18 patients in right. Results All of these 44 operations were successful, no cases convert to open surgery. 1 case for kidney seeper was misdiagnosed as renal pelvis cyst. And double J tube was placed intraoperative and no leakage of urine. All of these cases had no complications after sutured.The average operation time was 35min. No obvious activity bleeding occured, and the average hospital stays after operation was 3~5 d. Histological studies showed 44 cases parapelvic cyst. Clinical symptoms repeatedly and recurrence under the imaging diagnosis were found during 3~18 months' follow-up in 45 cases. Conclusions The transperitoneal laparoscopic parapelvic cyst unroofing have the advantages of clear surgical field, less trauma and rapid recovery. It is an effective treatment for the renal pelvis cyst. Key words: Kidney Pelvis; Cysts; Laparoscopes

UROLOGY RETROPERITONEOSCOPY: INITIAL EXPERIENCE IN CIPTO MANGUNKUSUMO HOSPITAL

Objective: This study was conducted to evaluate the initial experience of retroperitoneoscopy surgery. Material &amp; method: This is a descriptive study with cross-sectional design. Data was collected from medical records of Urology Department in Cipto Mangunkusumo General Hospital Jakarta, from March 2013 until February 2014. Subjects were all patients who performed retroperitoneoscopic surgery between the time periods. Results: Patients consisted of 9 males (42.85%) and 11 females (57.14%). Mean age was 38.95 + 21.88 years old. Proportion based on diagnosis were 5 renal failures (23.8%), 5 ureteral stones (23.8%), 3 renal cysts (14.3%), 2 PUJOs (9.5%), double 3 collecting systems (14.3%), 1 tumor (4.8%), 1 ureteral tumor (4.8%), and 1 renal diverticle (4.8%). Proportion based on kind of retroperitoneoscopy were ureterolithotomy (23.8%), nephrectomy 3 (14.3%), nephroureterectomy 3 (14.3%), renal cyst unroofing 3 (14.3%), heminephrectomy 3 (14.3%), pyeloplasty 2 (9.5%), partial nephrectomy 1 (4.8%), and diverticle coagulation 1 (4.8%). Mean operating time was 178.81 + 55.72 minutes with mean length hospitalization 8.05 + 4.4 days. Mean amount of bleeding was 98 + 69.47 cc, wound operation infection 0 (0%), peritoneal perforation 1 (4.76%), open surgery conversion 2 (9.52%), and transperitoneal laparoscopy conversion 1 (4.76%). Conclusion: In this study, total number of retroperitoneoscopy surgery cases still less than others abroad. Demographic characteristic showed variety than other study. Compared to other studies, the operating time was comparable but the length of stay was longer. We had higher open surgery conversion rate, while another complication was relatively the same.

Surgical treatment of hydatid cysts with large biliocystic fistula results from a monocentric surgical experience

Background: Hydatid cyst opened in the biliary tract constitutes an evolutionary turning point in the hydatid disease and risks to be life-threatening. Liver hydatid cysts with large biliocystic fistula is defined by the presence of a biliocystic fistula which is more than 5 mm in diameter and / or the presence of hydatid material in the common bile duct. The diversity of the pathological lesions of this disease and the lack of randomized controlled trials studying the different therapeutic techniques make those attitudes varied and sometimes debated. The purpose of this study was to study the different therapeutic possibilities as well as the difficulties posed by the large biliocystic fistula.Methods: This is a retrospective study of all consecutive patients (n=51), operated on for liver hydatid cysts with a large biliocystic fistula, between January 2003 and December 2012. The average age in this series was 39 years. There were 21 men and 30 women. An acute cholangitis was present in 47% of cases.Results: The treatment of hydatid cyst was conservative (cyst unroofing) in 90% of cases and radical in 10% of cases. The large biliocystic fistula was treated by internal transfistulary drainage (21%), cystobiliary disconnection by trans-parieto-hepatocystic fistulisazion (35%), bipolar drainage (25%), direct suture of the fistula (8%) and liver resection (10%). The specific morbidity rate was 27% (n = 14). No deaths have been observed. The average follow-up was 22 months. Six cases of recurrence were observed.Conclusions: The treatment of intrabiliary rupture of echinococcal cysts is not consensual. The internal transfistulary drainage and the transparietohepatocystic fistulization represent the techniques of choice in case of conservative surgery. Prevention remains the best treatment.