In spite of the improvement in imaging modalities and increasing recognition of biliary cystadenoma and cystadenocarcinoma, accurate preoperative diagnosis may be difficult. Complete surgical removal (liver resection or enucleation) of these lesions yields satisfying long-term results.

Frank intrabiliary rupture is an important complication of liver hydatid cysts and its incidence is between 5 and 25 per cent. The main principles of management are the surgical treatment of the cyst with removal of all cystic elements and drainage of the biliary tree. Accurate pre- and intra-operative diagnosis and permanent drainage of the biliary tree by a wide choledochoduodenostomy are important to reduce morbidity and mortality. In this report 28 cases of frank intrabiliary rupture of hydatid cysts treated by choledochoduodenostomy are presented.

Surgery is the main modality in the treatment of hepatic hydatid disease. In this report, a laparoscopic surgical method is described, and the results in the first 16 cases are presented. The method involves the use of an aspirator-grinder apparatus that achieves effective evacuation of viable cyst contents with the patient benefiting from the laparoscopic approach. Cavity infection occurred in two patients and was treated conservatively. In another patient, postoperative ultrasonography revealed a thick-walled cavity containing a dense fluid. Because the patient was symptomatic, pericystectomy was performed during the sixth postoperative month. Early postoperative parameters and the early follow-up results in other patients (2-17 months) are encouraging. The method is particularly suitable for uncomplicated, early-stage cysts located in laparoscopically accessible locations.

No abstract

Fatty tissue within the internal cremasteric fascia is frequently encountered during hernia surgery, and it is called a cord lipoma in the surgical literature. Between 1997 and 2001, 128 consecutive patients with 139 indirect inguinal hernias, who underwent open repair, were evaluated. A total of 100 lipomas of the spermatic cord or round ligament were identified and resected in 92 patients. There were no reported neoplastic changes noted in histopathologic examinations of the specimens. The incidence of cord lipoma associated with indirect inguinal hernia was 72.5%. Average body mass index (BMI) was 25.7 in patients with lipoma and 24.6 in patients without lipoma ( P=0.048). The incidence of cord lipoma in large hernias (Nyhus Type II and IIIb) was higher in our patients ( P<0.005). It can be clearly seen during laparoscopic exploration of the preperitoneal space that cord lipoma is a continuation of extraperitoneal fat tissue. We believe that even if there is no peritoneal sac, the herniation of extraperitoneal fat through the inguinal canal should be counted as an inguinal hernia, and it requires treatment.

Surgery is still the main modality in the treatment of hepatic hydatid disease. Laparoscopic methods, with their low morbidity, have gained prominence in many fields and, in some cases, have nearly replaced open surgery. In this report, a laparoscopic method for the treatment of hepatic hydatid disease is described and the results in the first six cases are presented. The method involves the use of an aspirator-grinder apparatus designed specifically for laparoscopic surgery. The postoperative courses of the patients were very comfortable and no complication related to the laparoscopic technique occurred. The method achieves evacuation of all viable cyst contents with the patient benefits of laparoscopic surgery. The apparatus practically eliminates the risk of spillage. The postoperative parameters and the early follow-up results (21-27 months) are very encouraging.

Percutaneous aspiration of purely cystic liver lesions was performed in 15 patients aged 11-56 years. After aspiration under guidance with computed tomography (CT) in 12 patients, a membrane that is diagnostic for hydatid disease was visible in the lumen of the cyst on CT scans. Hypertonic saline was injected in the cystic cavities of these patients as a scolecidal agent. No major complications occurred during or after the procedures. In the follow-up period of 6-16 months, control CT and ultrasound scans revealed a progressive decrease in the size of the lesions and no evidence of peritoneal seeding. It is concluded that percutaneous aspiration and hypertonic saline injection for purely cystic hydatid disease of the liver seem to be an effective form of treatment and may eventually prove to be an alternative to surgical intervention.

Endoscopic sphincterotomy should be the first-line treatment for postoperative external biliary fistulae related to hepatic hydatid disease.