Page 9 - WJOLS - Laparoscopic Journal

WJOLS

10.5005/jp-journals-10007-1108
ORIGINAL ARTICLE Laparoscopic versus Open Management of Hydatid Cyst of Liver
Laparoscopic versus Open Management of

Hydatid Cyst of Liver

Falih Mohssen Ali
Consultant Surgeon, Basrah Teaching Hospital, Iraq

ABSTRACT

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.
Keywords: Laparoscopical treatment, Liver, Hydatid cyst, Abdominal approach.

INTRODUCTION germinal membrane gives rise to broad capsules, which
contain the scoleces and daughter cysts, which float
Hydatid disease is a rare entity primarily affecting the
population of developing countries. Septation and freely in the clear cyst fluid.
calcification of the cysts with a high antibody titer in the 5. Surgery remains the gold standard in terms of therapy
patient’s serum confirm the diagnosis, although more for patients with hepatic hydatid cyst. Despite significant
sophisticated tests have been applied recently. Surgery advances in medical treatment and interventional
constitutes the primary treatment with a variety of techniques radiology, the conventional operative procedures of the
based on the principles of eradication and elimination of hydatid cyst of the liver, like enucleation, cystectomy,
recurrence by means of spillage avoidance. evacuation, marsupilization, etc., which involve a
1. Hydatid disease is endemic mainly in the significant morbidity especially in term of wound
Mediterranean countries, the Middle East, South infection are used. Laparoscopic treatment of hepatic
America, India, Northern China and other sheep-raising hydatid disease has been increasingly popular parallel to
areas; however, owing to increased travel and tourism the progress in laparoscopic surgery.
all over the world, it can be found anywhere, even in 6. Controversies about the role of laparoscopy in the
developed countries. Hydatid disease is a zoonotic management of liver hydatid cyst have not been resolved;
infection caused by adult or larval stages of the these controversies include selection of patients and
cestode Echinococcus granulosus. surgical technique. This study presents our experience
2. The prevalence of hydatid disease among human was and results in laparoscopic treatment of hepatic hydatid
determined as 9.1% in a World Health Organization study cysts. 1-3
in central Peruvian Andes.
3. In humans, most hydatid cyst occur in the liver and PATIENTS AND METHODS
75% of these are single cyst and other common organs From November 2007 to January 2010, 32 patients with
included are lung, spleen and kidney. liver hydatid cyst were treated laparoscopically in the
4. The hydatid cyst of the liver has two layers: The Department of General Surgery, Ain Shams University
ectocyst—a dense fibrous host reaction to the parasite, Hospital, Cairo, Egypt and New Al-Jedaani Hospital,
and the parasite—derived endocyst which has an outer Jeddah, Saudi Arabia. The study group consisted of 14 men
laminated and an inner germinal layer. The single-celled and 18 women. Ages ranged from 26 to 63 years (mean

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