Management of complex liver cystic hydatidosis: challenging benign diseases for the hepatic surgeon

Fancellu, Alessandro; Perra, Teresa; Vergari, Dario; Vargiu, Isabel; Feo, Claudio F; Cossu, Maria Laura; Deiana, Giulia; Porcu, Alberto

doi:10.1097/md.0000000000023435

Cited by 8 publications

(5 citation statements)

References 33 publications

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“…In CE2 (multilocular cyst) and CE3B (cyst with daughter cysts and cyst with solid contents) cysts, the PAIR technique or surgical treatment is used; for type CE4 (cyst with heterogeneous contents) and CE5 (solid cyst with calcifications) surgical treatment is not required. However, in the presence of complications (cystobiliary fistula, suppuration), various treatment options are available ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical, Morphological Justification and First Experience in the Use of Radiofrequency as well as Microwave Ablation Treatment Methods of Liver Echinococcosis

Шабунин¹,

Karpov²,

Bedin³

et al. 2023

IJPA

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Background: The current study considers a new direction of surgical treatment of liver echinococcosis - the use of minimally invasive treatment methods of parasitic cysts. Methods: After clinical and morphological substantiation of the very possibility of carrying out such procedures, 9 microwave ablations (MWA) and 3 radiofrequency ablations (RFA) of cysts were performed in patients with liver echinococcosis from 2017 to 2021 in the surgical clinic of Botkin Hospital, Moscow, Russia. A comparative analysis of treatment results of patients with echinococcal liver cysts (12 patients who underwent “percutaneous puncture, aspiration, injection and reaspiration” (PAIR) procedure and 12 patients – MWA and RFA) was carried out. Results: The number of complications according to Clavien-Dindo classification was as follows: 8 after PAIR procedure, 3 after RFA and 3 after MWA. The median hospital length of stay (LOS) after PAIR procedure was 6.46 days versus 4.7 and 4 in the groups of patients who underwent RF and MW ablation, respectively. The frequency of relapses within the first year after PAIR procedure was 25%. The patients who underwent ablation procedures had no relapses of liver echinococcosis during observation. Conclusion: The presented clinical and morphological substantiation and the experience of using various types of ablation techniques on echinococcal cysts, as well as a comparative analysis with a commonly used PAIR treatment method, demonstrated the safety of RFA and MWA for the patient and efficacy in relation to the hydatid process.

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Section: Discussionmentioning

confidence: 99%

Clinical, Morphological Justification and First Experience in the Use of Radiofrequency as well as Microwave Ablation Treatment Methods of Liver Echinococcosis

Шабунин¹,

Karpov²,

Bedin³

et al. 2023

IJPA

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“…Cysts larger than 15 cm, or compressing main vascular structures, or located in both hemilivers should be considered, as well as complicated cysts, in the category of complex hydatid cysts [11] .…”

Section: Clinical Discussionmentioning

confidence: 99%

“…Surgery for complex hydatid cysts of the liver is potentially burdened by serious complications. This kind of benign liver disease requires skill-demanding procedures and should be treated in centers with expertise in both hepato-biliary surgery and hydatid disease management [11] .…”

Section: Clinical Discussionmentioning

confidence: 99%

Hepatic mass caused by Fasciola hepatica: A case report

Adhikari

Poudel²,

Pradhan³

et al. 2022

International Journal of Surgery Case Reports

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“…Intrabiliary rupture or cystobiliary fistula is the most common complication of hepatic hydatid cyst and occurs in 3-42% of cases (11,12,17). While the pressure of a normal bile duct system is 15-20 cm H2O, there is a pressure of about 35 cm H2O in the cystic cavity of hydatid cysts.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of liver hydatic cyst and evaluation of cystobiliary fistula: experience of two centers

Dizen

Kaya

2022

Journal of Health Sciences and Medicine

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Objective: Intrabiliary rupture or cystobiliary fistula is the most common complication of hepatic hydatid cyst. In this article, our objective is to evaluate the clinical, laboratory, imaging, surgical treatment and results of cystobiliary fistulas, which is the most common complication of hydatid cysts. Material and Method: In our study, patients who underwent open surgery and were followed up and treated for hydatid cyst in the gastroenterology and general surgery outpatient clinic and service between years 2015-2021 were included. The clinical, laboratory, radiological and surgical results of 171 patients with hydatid cysts were retrospectively analyzed. Results: The mean age of 171 patients who underwent surgery for hydatid cyst was 44.8 (18-71), 68 of whom were men and 103 were women. Bile leakage was present in 50 patients (50 (29.23%)). There were 24 (48%) men and 26 (52%) women with bile leakage. The cyst diameter was 74.2 (36-170) mm and the number of cysts was 1.2 (1-2). The cysts were located in the right lobe of the liver in 116 (79%) patients, in the left lobe in 30 (15%) patients, and in both lobes in 25 (6%) patients. Cystobiliary fistula developed more frequently, especially in cysts located in the right lobe(36 (72%)). Cystobiliary fistula was most common in CE3 (Gharbi type 2) type (30 (60%)). Cystectomy+drainage was performed in 137 (80%) patients in all groups. Cystectomy and drainage were the most common surgical procedures. The cyst diameter was 10 cm in the group with cystobiliary fistula and was significant compared to the group without fistula (p<0.001). Aminotransferase (AST and ALT) levels were high in patients with cystobiliary fistula (p=0.012, p=0.054). However, there was no significant difference between the two groups in alkaline phosphatase, total bilirubin, and gamma glutamyl transferase (p=0.231, p=0.097, p=0.544). Conclusion: Liver hydatid cyst is endemic in our country as well as in many other countries in the world. Complicated hepatic hydatid cysts require timely and appropriate treatment because of their life-threatening complications. Cytobiliary fistula is the most common complication. In the surgical treatment of hydatid cyst disease, the earlier the diagnosis of occult cystobiliary fistulas is made (especially in the preoperative or peroperative period), the easier the treatment is, and the risk of bile leakage and consequently the morbidity and mortality decreases. Our results and experience showed that treatment and complications are related to the location and size of the cyst, occult/large cystobiliary fistula, detectability of occult fistulas, experienced center and surgeon.

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Management of complex liver cystic hydatidosis: challenging benign diseases for the hepatic surgeon

Abstract: Supplemental Digital Content is available in the text

Cited by 8 publications

References 33 publications

Clinical, Morphological Justification and First Experience in the Use of Radiofrequency as well as Microwave Ablation Treatment Methods of Liver Echinococcosis

Clinical, Morphological Justification and First Experience in the Use of Radiofrequency as well as Microwave Ablation Treatment Methods of Liver Echinococcosis

Hepatic mass caused by Fasciola hepatica: A case report

Surgical treatment of liver hydatic cyst and evaluation of cystobiliary fistula: experience of two centers

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