Surgical treatment of hepatic hydatid disease

Abstract

The results of surgery in 48 patients with hepatic hydatid disease are described. In 26 out of 32 patients with uncomplicated cysts, conservative surgery with obliteration of the cyst cavity by omentoplasty gave satisfactory results. In contrast, 16 patients with cysts complicated by pyogenic infection or cholangitis required a variety of surgical procedures, including prolonged tube drainage, exploration of the common bile duct, sphincterotomy/plasty and hepatojejunostomy to achieve a satisfactory outcome. The group with complicated cysts also had a much longer postoperative stay (median 30 days) than those with uncomplicated cysts (median 14 days). Two patients died: in one, post-mortem examination revealed carcinoma in the wall of the cyst.

A novel modified PAIR technique using a trocar catheter for percutaneous treatment of liver hydatid cysts: a six-year experience

“…In WHO informal working group on echinococcosis 2010 guidelines, it is stated that possible methods for the treatment of the hydatid cyst have not been compared and there is no "best treatment option" (7). Traditional treatment is surgical; however, mortality (0%-6.3%), complication (12.5%-80%), and recurrence (2.2%-22%) rates of this modality are high (8)(9)(10). Medical treatment alone is not efficient, but it can be used as an adjunct before or after the percutaneous treatment as a prophylaxis for abdominal dissemination (9,11).…”

Surgical management of complicated hydatid cysts of the liver

“…In a series of 155 cases of liver hydatid, omentoplasty was associated with a significantly lower incidence of external fistula and infection compared to external drainage [3] . Dawson et al [20] conducted a study involving 48 patients and concluded that omentoplasty is the best technique as it is associated with shorter hospital stay and lower incidence of biliary fistula. In our study, four cysts were drained internally in the form of choledochoduodenostomy in one patient and choledochojejunostomy in three patients.…”

Controversies in the Surgical Management of Hydatid Disease of the Liver

“…Partial decompression of the cyst, which is usually at a pressure of 300-700 mm of water [2], prevents explosive spillage [27], Ready availability of multiple wide-tubing suckers is essential, as cyst contents will frequently block suction devices during evacuation [5]. The use of the cryogenic cone or the newer Aaron's suction cone [28] which avoids 278 SHARMA and MOJUMDER MJAFI, 51: 4, OCTOBER 1995 cryogenic damage to the liver capsule and adjacent organs makes deliberate evacuation of the cyst relatively safe but requires a wide thoracoabdominal incision to place the cone on the superio-lateral surface of the liver which is a common location of hydatid cysts.…”

“…There is, however, considerable disagreement about the preferable surgical technique. The major issue of debate is whether complete removal of the peri-cyst is necessary to cure the disease [5,11,12,28,29]. Conservative procedures entail the complete removal of the ectocyst and its contents, if possible by enucleation, to prevent spillage.…”

“…These are most commonly seen after the residual cavity is managed by capitonnage (approximating the cyst walls with successive layers of transfixing sutures [5]). The residual cavity can be managed by opening it widely by performing a partial peri-cystectomy (excision of the extraheaptic portion of the pericyst) so that the cyst-biliary communications can be dealt with by direct suture ligation, followed by omentoplasty which is the technique of choice in most cases of hepatic hydatidosis [12,13,15,28]. In case the omentum is short and the liver soft and pliable, as in children, the technique of introflexion, in which the liver is folded in on itself, can be used to obliterate the residual cavity [31].…”