Page 12 - WJOLS - Laparoscopic Journal

Falih Mohssen Ali

Fig. 4: Computed tomography (CT) scan appearance of a large Fig. 6: Multiple hydatids liver that required postoperative
hepatic cyst albendazole therapy

DISCUSSION
In our study, 72.8% of the patients were symptomatic,
while 27.2% were asymptomatic. In all of the patients, the
cysts found were ≥ 6 cm. The choice of the better
management of hydatid cyst of the liver is very difficult
because of variable clinicopathological aspects. The
treatment should be individualized to the morphology, size,
number and location of the cysts. Hydatid liver disease is
still endemic in certain regions of the world. The incidence
of hydatid disease in Turkey ranges from 2/10,00,000 to
1/2,000 in different studies. The progresses fulfilled in the
latest years by laparoscopic management have made the
applications of this technique possible to a more and more
number of growing cases. It is sure that the Palanivelu
Hydatid System (PHS) has revolutionized the treatment of
hydatid cyst of the liver because this sealed procedure
not only avoids any spillage of the fluid but also allows
Fig. 5: Magnetic resonance imaging of sagittal hepatic cysts
intracystic magnified visualization for cyst biliary
contact of hydatid fluid to blood stream after accidental communications. By its application, fields are excluded only
laceration of the liver. Bile leakage was observed in one deep intraparenchymal or posterior cysts situated close to
patient on the second postoperative day, which was managed the vena cava. Consequently, reduced time range
by endoscopic sphincterotomy. The leakage gradually ceased hospitalization that is for the laparoscopy, in the opinion of
within 6 days. This patient was discharged on the tenth some authors, of 3 to 12 day against the mean hospitalization
postoperative day, in other patient, an infected subhepatic time range in the open that is of 9 to 20 days; mortality with
collection developed after discharge from the hospital. the laparoscopic procedure goes down to almost 0% and
This patient was rehospitalized with pain and high fever, morbidity has determinate dramatic and sensible reduction
and the collection was drained percutaneously guided by of the recurrence. 8,9
ultrasound. The mean length of hospital stay was 4.3 days CONCLUSION
(range 4-10 days). The mean follow-up was 15.6 months
(range 6-25 months). Radiological and serological test results It is better and safe to use laparoscopy in treatment of hydatid
showed no recurrences for all patients. liver with less morbidity, mortality and recurrence rate in
comparison with open technique.
Table 1: Symptomatology of patients with liver hydatid cyst It is recommended to use postoperative albendazole
therapy.
Symptom No. %
Pain 18 56.20 REFERENCES
Abdominal mass 12 37.50 1. Dervenis C, Delis S, Avgerinos C, Madariaga J, Milicevic M.
Dyspepsia 4 12.50
Jaundice 2 6.25 Changing concepts in the management of liver hydatid disease.
J Gastrointest Surg. Jul-Aug 2005;9(6):869-77.

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