Page 11 - WJOLS - Laparoscopic Journal

WJOLS

Laparoscopic versus Open Management of Hydatid Cyst of Liver
Radical Surgery to another suction machine is introduced into the cannula

In the pericystectomy technique (Fig. 3), the cyst was and is pushed into the cyst. The suction is immediate and
totally removed together with 1 cm of the liver happens either into the body of the hollow trocar and into
parenchyma, without opening the cavity. In a left lobe the suction cannula, or into cannula and then into the suction
lateral segmentectomy, to secure the vasculature of the side-channel.The trocar is removed, the peritoneal cavity is
left lobe lateral segment, the segmentectomy was irrigated by the main channel while the suction is maintained
performed after taking the mesentery. In both situations, all the time. After removing fluid, the telescope is introduced
drain put in area of operative field. to visualize the interior of the cavity for control any cyst-
biliary communication; a scolicidal agent is instilled into the
Conservative Surgery cyst cavity and after 10 minutes it is suctioned and the cyst
is marsupialized. In case of bile leakage, use of scolicidal
The anterior wall of the cystic lesion was removed as widely agent is avoided. 10,11
as possible. All the components of the cyst were removed Although the rate of recurrence is lower with radical
from the interior. After washing the operated area with saline surgery, application is limited as the associated morbidity
or Betadine solution, one or two drains were placed. and mortality rates are high. In the radical surgery cases
6
Omentopexy was not performed when cysts were located in our study, four were in the left lobe lateral segment
proximally but was performed when cysts were located with straightforward localization and the other 14 were
inferior to the liver. 5-7,9 exophytic locations, therefore, there was no mortality or

morbidity related to surgery. The laparoscopic approach
Contraindications
is a treatment method developed in recent years using an
1. Deep intraparenchimal cysts umbrella trocar to perform partial or total cystectomy. 6,7
2. Posterior cyst
3. More than three cysts ALBENDAZOLE TREATMENT
4. Cysts with tick and calcified walls All patients with hydatid disease the size was seen to have
5. Cysts characterized by heterogeneous complex mass increased, firstly albendazole treatment was administered.
(Gharbi type 4 ) When the size continued to increase despite this, then surgery
6. Cyst less than 3 cm in diameter was planned at our clinic were administered
7. Serious coagulation abnormalities. 10 mg/kg albendazole for 14 to 21 days preoperatively.
During this period, liver function tests were closely observed.
TECHNIQUE For all patients undergoing surgery, the same treatment
protocol was recommended on postoperative day 1 and
After creating pneumoperitoneum through the umbilicus and
after identifying the hydatid cyst, the PDS trocar is continued for 14 to 21 days. If patients experienced
introduced into the peritoneal cavity directly over the hydatid recurrence during follow-up, again 14 to 21 days treatment
cyst. Once the trocar is removed only the cannula is was administered preoperatively, and the postoperative
advanced until its tip is in contact with the hydatid cyst treatment period was 2 months (Figs 4 to 6).
surface. After suction with cannula, a 5 mm trocar joined RESULTS
Around 32 patients (18 women and 14 men) with liver
hydatid cyst underwent laparoscopic cystotomy and partial
cystectomy during the study period from November 2007
to January 2010. The presenting symptoms of patients is
shown in Table 1. Abdominal ultrasound, abdominal
computed tomography and serological examination
(immunoelectrophoresis) confirmed the diagnosis of hepatic
hydatid cyst in all patients. A total of 28 patients had solitary
liver cyst and four patients had two cysts; 16 cysts located
in segment 6, 12 cysts located in segments, four cysts
located in segment 3 and four cysts located in segments 4.
Mean operative time was 54 minutes (range 45-130 minutes).
No conversion to open procedure was required. We had
one case that devolped an aphylaxis during procedure but
Fig. 3: Pericystectomy recovered well, the anaphylaxis devolped secondary to direct

World Journal of Laparoscopic Surgery, January-April 2011;4(1):7-11 9