Introduction: Hydatidosis is the result of infection with the larval stages of some species of the genus Echinococcus. Treatment approaches for hydatid cysts include the use of albendazole, surgery, and/or medico-surgical procedures. The choice of the therapeutic surgical approach depends on the cyst number and localization, surgeon expertise, and presence of complications. The present study aimed to compare the outcomes of the following therapeutic approaches for the treatment of hepatic hydatid cysts: pericystectomy; the puncture, aspiration, injection, and reaspiration (PAIR) technique; and the PAIR technique followed by deroofi ng, evacuation of cysts, and omentoplasty. Methods: The 54 patients were divided into 3 groups: Group I (14 patients) who underwent pericystectomy, Group II (23 patients) who underwent the PAIR technique, and Group III (17 patients) who underwent the PAIR technique followed by deroofi ng and omentoplasty. The diagnosis of hydatid cysts was based on serological testing using enzyme-linked immunosorbent assay, abdominal ultrasound, and parasitological examination of the cyst contents. Morbidity, mortality, length of hospital stay, recurrence, and postoperative complications were evaluated. Results: Postoperative bleeding, infection, and recurrence were reported in Groups I and II; Group III did not experience postoperative infection and had shorter hospital stays. Recurrence and postoperative complications did not occur in Group III. Conclusions: The partial surgical procedure with deroofi ng, evacuation of the cysts, and omentoplasty, as performed in the present study, is recommended as a safe and effective method for elimination of the entire parasite with minimal possibility for intra-peritoneal spillage.

Background: The pain pattern after laparoscopic cholecystectomy (LC) is complex and distinct from postoperative pain after other laparoscopic procedures, suggesting that procedure-specific optimal analgesic management plans should be proposed. Duloxetine, a non-opioid neuromodulator, has been widely used to manage pain with dual central and peripheral analgesic properties.Aims: To assess the effect of preoperative administration of duloxetine compared to placebo on postoperative pain control in patients undergoing LC.Patients and Methods: This study was a randomized, parallel-group, placebo-controlled, double-blinded study performed on patients undergoing LC. Patients were randomly divided into two groups of 30 each on the day of surgery in the preoperative holding area, using a computer-generated random number to receive 60 mg duloxetine as a single oral dose 2 h before the procedure or placebo. The primary outcome was the difference in the mean of visual analogue scale (VAS) scores between the two studied groups, as measured by the area under the curve (AUC) of the VAS scores.Results: The derived AUC of VAS scores in the duloxetine group (757.89 ± 326.01 mm × h) was significantly lower than that calculated for the control group (1005.1 ± 432.5 mm × h). The mean postoperative VAS scores recorded at 4 and 24 h were statistically different between the study groups (p = 0.041 and 0.003, respectively). As observed in the survival curve analysis, there was no significant difference (p = 0.665) for the time until the patient’s first request for rescue medications in the two groups. The frequency of postoperative nausea and vomiting (PONV) was lower in patients of the duloxetine group than that recorded in those allocated to the control group at 8 and 24-h time intervals (p = 0.734 and 0.572, respectively).Conclusion: Preoperative use of duloxetine reduces postoperative pain significantly compared with placebo. In addition, its use is associated with a reduction in PONV. These preliminary findings suggest that duloxetine could play a role in the acute preoperative period for patients undergoing LC.Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT05115123, identifier NCT05115123],

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SummaryThe aim of the current work was to evaluate the possibility of using a rapid and simple reagent strip test to investigate the viability of hydatid cysts intraoperatively, via testing certain biochemical parameters. Thirty eight HCF samples were processed and examined by different methods for determining the viability status. Using the reagent strip test in the current study, the highest signifi cant level of glucose was detected in HCF samples with the highest viability % at pH 7.5 and the lowest signifi cant level of glucose was detected in HCF samples with the lowest viability % at pH 8.5, indicating a likely correlation between glucose concentration and the viability of PSs. On the contrary, protein was not detected in HCF containing viable PSs and was found to be higher in HCF containing non-viable PSs, denoting the possible degenerative processes in such PSs. Haemoglobin was found in trace amounts in all of our samples. In addition, the strip test detected bacterial contamination in 8 samples and biliary leakage in 7 samples. Our results suggest that the simple reagent strip test can assist in providing fast, uncomplicated primary data regarding the viability status of the hydatid cysts. Thus, it may aid the surgeons to make informed decisions for further management and appropriate follow up to minimise the risk of post-operative recurrence.

Background: Cystic echinococcosis (CE) is a zoonotic infection that occurs worldwide, particularly in endemic areas in the Middle East, including Egypt. Echinococcus granulosus (E. granulosus) eggs can be accidentally ingested by human in contaminated food or drinks and reach primarily the liver forming hydatid cysts with reported predilection for the right lobe. However, the segmental orientation of hepatic echinococcosis in the light of the clinical presentation and serological findings needs further investigation as such correlation may carry additional clues to guide the therapeutic management and prognostic outcomes. Objectives: The present study was designed to determine the relation of anatomical location of intrahepatic hydatid cyst to its development, activity, and host immune response; as well as its potential extrahepatic spread. Patients and Methods: A total of 46 patients having liver hydatid cysts were evaluated. Intrahepatic cysts were categorized according to Couinaud's segments by ultrasound examination; and analysis was done regarding cyst size, cyst staging and activity, and extrahepatic spread, in addition to clinical features and patterns of IgG level using two serodiagnostic tests IHA and ELISA. Results: Hydatid cysts were found in all segments with the exception of segment I. Active cysts were mostly found in segment VII (no. = 11; 47.8%), recording a large diameter size with a mean of 6.55 cm. Inactive cysts recorded statistically significant smaller diameters with a mean of 5.55 cm denoting cyst evolution and degeneration. Serum antibody level correlated significantly with radiological profile of cysts activity in the studied population. Finally, extrahepatic spread was observed in hydatid cysts involving all liver segments with the exception of segment V. Conclusion: Hydatid cysts were found in liver segments II through to VIII. While cysts in segment VII demonstrated large sized active cysts with extrahepatic spread, cysts confined to segment V pose minimal risk for extrahepatic spread.

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