Page 35 - WJOLS - Surgery Journal

Alaa Bakir Raheem

There were many modalities and suggestions in the treatment (1-4 weeks), as well as postoperative and with preoperative
and management of liver hydatid disease (scollicidal injection antibiotics (usually third-generation cephalosporins). While in
and controlled rupturing, reaspiration of cyst). PAIR (injection other study after the cysts were identified. Three to four trocars
with scollicidal and percutaneous reaspiration under ultrasound were required for each operation according to cyst (cysts)
guide) but controlled rupturing injection. Reaspiration remain locations. A long, 10/12 mm trocar was Introduced from a point
the option of choice whether it is open or laparoscopic safely as close as possible to the cyst, and two long strip of gauze
performed. soaked with hypertonic sodium chloride solution as a scolecidal
The open conservative surgical approach is the most agent were placed around the cyst. The cyst was then punctured

accepted approach for recurrent giant cysts and on the same with a 14 gauge 120 mm needle and the cyst content was rapidly
principles, the laparoscopic approach developed which based aspirated. At that moment, an additional aspirator tip was placed

on the creation of an isolatedhypobaric system, through which close to the puncture point to avoid spillage of cyst contents.

the cysts can be managed without spillage of their content 5 The cyst cavity was then nearly filled with hypertonic sodium
there were many studies was done to evaluate and combines chloride solution for irrigation, which was left in the cavity for

the effectiveness of open surgery with the advantages of the 5-10 minutes. In the next step, the cyst wall was opened and the
laparoscopic approach with different techniques and endocyst was evacuated into a specimen-retrieval bag with
theoretically solving the problems of access and preventing careful observation of the separation from pericyst. The cystic
spillage of cyst content following controlled rupturing of cyst cavity was reirrigated with hypertonic saline and the telescope
to get rid from acute setting of anaphylaxis during cyst control was introduced into the cavity to explore for potential biliary
rupturing laparoscopically if spillage occur. As well as in open, openings and retained daughter cysts. The procedure was
surgery these studies was done in a specialized institutions for completed with partial un roofing, and closed-suction drains
laparoscopic surgery. were placed into the cysts with subhepatic or perihepatic
drains. 19
CONTENT While Martin Ertem et al did other procedure of attaching
Treatment of liver hydatid disease via laparoscopic approach, the cyst is little difference in this study 13 they introduce

based on the creation of an isolated hypobaric system, the 3 gauzes intothe abdominal cavity, placed around the cyst, and

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initial attempts at 1994 then the first report of laparoscopic soaked with10% povidone iodine solution as a scolecidal agent.

treatment of hydrated cyst of the liver was published in 1994 17 The cyst was punctured with a 14 gauge 6F aspiration needle.

and was followed soon thereafter by the first report of As a precaution, the tip of a 5 mm suction catheter was placed

anaphylactic shock complicating laparoscopic treatment of close to the puncturesite, and as much as cystic fluid as possible
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hydatid cysts of liver. In fact, an exaggerated fear of was aspirated, so that when the endocyst (germinative

anaphylaxis seemed to discourage surgeons from more widely membrane) detached from the cystic wall and shrank to the

adopting minimal access techniques for the treatment of bottom of the cyst when. The deflatedcystic wall was suspended

hydatid cysts. 16,18 However, gradually reports started by 2 graspers, and cystotomy was performed.At this stage, the

appearing in the world literature detailing laparoscopic 11 mm trocar was exchanged for an 18 mm one.A transparent

management of liver hydatid disease through which the cysts tube with a 15 mm internal diameter was inserted through the

can be managed without spillage of their content 14,15 the 18 mm trocar, and the germinative membrane was aspirated. A

technique combines the effectiveness of open surgery with hose of the same diameter was connected to the transparent

the advantages of the laparoscopic approach. The chosen tube, and the entire membrane was removed. In all cases, the

patients with no selection criteria underwent consecutive telescope was inserted into the cyst to explore for potential

laparoscopic operations for symptomatic liver hydatid cyst. biliary openings and retained daughter cysts. Thecystic cavity
then irrigated with 20% hypertonic saline, and unroofing was
METHOD OF INTERVENTIONS performedby partial or near-total cystectomy, a drainwas placed

The main surgical maneuvers are: (injection, control rupture in the cystic cavity. Gauzes and pieces of the excisedcystic wall
reaspiration) were performed through an assembled transparent were placed in an endo sac and removed.
cannula, in which a vacuum was created, while its tip adhered Albendazole (10 mg/kg per day) was administered
firmly to the cyst wall. Following evacuation of the cyst contents postoperatively to all patients.
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and deal with the procedure of the drainage accordingly. In Follow-up by US every 3 months during the first year, then
one study the procedures performed urgently in nearly halves by US and CT every 6 months during the second year. The
of the patients and in more than half of the patients the procedure result of this study although have little drawback but enco-
done on an elective basis. uraging regarding hospital stay time consume early return to

All patientswere treated with albendazole (400 mg twice a work resume normal activity dealing with other pathology remote

day, or 12 mg/kg when weight was < 60 kg) prior to operation from operative site like in this study surgical procedures for
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