Surgical Alternatives Used in the Treatment of Liver Hydatid Cyst: A Systematized Approach Based on Evidence (an Overview)

Abstract

Echinococcosis is an endemic zoonosis in the south of Chile; we therefore have occasion to treat a large number of patients, particularly in the liver. Hepatic echinococcosis (HE) has its own morbidity and mortality due to evolutionary complications, to which the risk of complications related to the surgical procedures is added, the morbidity which has been reported up to 80 %. This is associated with a history of previous surgeries for HE, evolutionary complications of the cyst, the need for additional procedures such as the treatment of the disease in other simultaneous locations, etc. Moreover, reported mortality is up to 10 %, a situation that remains unchanged despite technological and therapeutic advances. The surgical treatment of HE can be divided into four phases: isolation of the surgical area, evacuation of the cyst, treatment of the complications of the cyst and treatment of the residual cavity. HE surgical procedures can be classified as conservative (marsupialization, cystostomy, Posadas technique and cystojejunostomy) and radical (pericystectomy and hepatic resections). Finally, the role of laparoscopic surgery, which is still under evaluation, is also worthy of note. The aim of this article is to present a general evidence-based overview of some surgical aspects of interest in the treatment of HE. In this article issues of the different surgical options utilized for HE treatment and their results are discussed, based on published evidence.

Factores asociados a complicaciones prequirúrgicas en pacientes con equinococosis quística de áreas endémicas del Perú

“…Es crucial identificar las complicaciones prequirúrgicas, porque permitiría una hospitalización oportuna, evitando complicaciones severas que podrían empeorar el pronóstico (21) o permitiría intervenciones más seguras y apropiadas para reducir el riesgo de morir. Además, las técnicas quirúrgicas han sido identificadas como un factor asociado al riesgo de morir (11)(12) y la intervención quirúrgica en la identificación de los factores de riesgo para desarrollar las complicaciones posoperatorias en hidatidosis podría ser un sesgo. En este estudio, se identificó que los pacientes con EQ mayores de 56 años tienen 3,05 veces la chance de presentar complicaciones prequirúrgicas en comparación con los que tienen 56 años o menos.…”

“…En las primeras, la desnutrición, el abdomen agudo y el empiema fueron las complicaciones más frecuentes (10) . Se sabe que la morbilidad en la hidatidosis hepática puede llegar hasta 80% y la letalidad hasta 10%, y que estarían asociados a complicaciones de la enfermedad y a los procedimientos quirúrgicos (11) .…”

“…Las técnicas quirúrgicas se han asociado al riesgo de morir (11)(12) y se han reportado hasta 20% de complicaciones en pacientes intervenidos quirúrgicamente (22) , por ello, consideramos pertinente estudiar los factores asociados a complicaciones prequirúrgicas.…”

Abdominal pain caused by a giant liver hydatid cyst and the management of the residual cavity in a tertiary public hospital in Greece

“…The management of the hydatid cyst’s residual cavity still remains a challenging problem, especially in giant hydatid cysts. Many ways of managing the residual cavity have been proposed depending on the size and location of the cyst, the presence or absence of complications and the surgeon’s experience: omentoplasty, external drainage, capitonnage and different combinations of them [6, 7]. Omentoplasty has the lowest surgical site infection (SSI) rate among all other surgical techniques even in combination with the other surgical techniques.…”

Turkish HPB Surgery Association consensus report on hepatic cystic Echinococcosis (HCE)

“…This procedure is de-fined as a partial cystectomy. After reducing the cystic cavity, management methods for the remaining space include unroofing, marsupialization, tube drainage, capitonnage, Roux-en-Y cystojejunostomy, and omentoplasty (65). There are studies comparing tube drainage, capitonnage, and omentoplasty in the literature.…”