Page 36 - WJOLS - Surgery Journal

Laparoscopic Treatment of Hepatic Hydatid Disease
inguinal hernia repair (trans-abdominal preperitoneal poly- is introduced into the cannula and, by steady pressure, is pushed
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propylene mesh plasty) was done in to one patient simul- into the cyst along with the cannula ). Any fluid spillage on
taneously and this also an advantages to laparoscopic puncture of the cyst wall is immediately suctioned either into
intervention. the body of the hollow trocar through its fenestrated tip and
While Palanivelu et al in india he advocate the 2 way canula then into the suction cannula or into the outer cannula and
for the treatment of liver hydrated cystes laparoscopically. then into the suction side channel. Once the PHS enters the
hydatid cyst, the trocar is removed and the cavity is irrigated
Palanivelu Hydatid System (PHS) through the main channel while simultaneously maintaining
continuous suction. In this way, fragments of laminated
The PHS consists of a trocar and cannula along with 5 and membrane, daughter cysts and debris are easily removed. Once
3 mm reducers. The trocar is 29 cm long. It is hollow throughout the returning fluid is clear, CO is insufflated at low pressure
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its length to accommodate a suction cannula (Fig. 1). Its tip is (3-4 mm Hg) and another telescope is introduced into the cavity
pyramidal shaped, with each facet of the pyramid bearing a through the cannula to visualize the interior for any overt cyst–
fenestration to enable any fluid leaking on its insertion to be biliary communication. In the absence of overt cyst–biliary
sucked into its hollow body by the cannula placed within. The communication (verified by the absence of bile staining in the
cannula is 26 cm long, with an inner diameter of 12 mm. It has suctioned fluid and nonvisualization of the opening within the
two side channels—one for gas insufflation and another for cyst cavity), 0.5% cetrimide is instilled into the cyst cavity as a
suction. The suction channel has an inner diameter of 10 mm. scolicidal agent. Separate telescopes should be used for intra
Its outer nozzle is designed so that the suction tube has an peritoneal and intracystic visualization to minimize the risk of
airtight fit on it.
anaphylactic shock. After 10 minutes, the scolicidal agent is
suctioned and the cyst is marsupial zed. The minor biliary leaks
that are seen near the cyst wall are sutured by laparoscopic
extracorporeal suturing with 3-0 vicryle. All patients were treated
with albendazole 10 mg/kg/day for at least 2 weeks pre-
operatively and continued postoperatively for 4 weeks patients
follow-up by US which was repeated at shorter intervals. CT
scan was performed if indicated in the follow-up period.
Resultes of palanivelu hydatid system (PHS)study: In 83.3%
of patients, only evacuation of the hydatid cyst by the PHS
was done. In 13.7%, this was followed by left lobectomy because
the cysts were surge almost the entire left lobe of the liver. The
remnant cavity was dealt with by omento plasty. The average
follow-up period was 5.9 years, during which there were no
recurrences. PHS is successful in preventing spillage,
The average duration of surgery was 52 minutes. None of
the patients in this study had intraoperative anaphylactic shock
which is the major concern . Postoperatively, two patients (2.7%)
Fig. 1: Special trocar used for hydatid cyst surgery had infection, whereas nine patients (12%) had a minor biliary
leak that stopped draining by 5-7 days. Out of the 75 patients,
TECHNIQUE regular follow-up was maintained for 59 patients, with an average
After introducing the camera port through the umbilicus follow-up period of 5.9 years. To date, there have been no
following creation of pneumoperitoneum, the hydatid cyst is recurrences. 16
identified on the surface of the liver. Then, the PHS trocar with In other study by Alexandra K Tsaroucha et al and
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cannula is introduced into the peritoneal cavity directly over Alexandros C. Polychronidis, (in North-Eastern Greece) over
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the hydatid cyst. Once inside the peritoneal cavity, the trocar is the last 20 years. In the period from 1984 to 2003. Same
removed and the cannula alone is advanced until its tip is in encouraging result they obtained to their patients.
total contact with the hydatid cyst surface. Suction is applied
through the side channel to maintain contact between the cyst STATISTICAL ANALYSIS
and the cannula opening. Continuous suction creates a vacuum Most statistical analysis used standard method of statistical

seal between the cyst wall and the rim of the cannula opening evaluation of the data performed using the Fisherexact test and

and prevents any spillage. Thereafter, the trocar with a 5 mm Goodman and Kruskal test. Results are expressed as median

suction nozzle inside (connected to another suction machine) ± SD. Differences were considered significantat P<.05.
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