Laparoscopic treatment of liver hydatid cystsBackground: Laparoscopic surgery is emerging as a useful alternative for the treatment of liver hydatid cysts. Aim: To report technical data, management protocols, costs and results of laparoscopic management of liver hydatid cysts. Material and Methods: Prospective analysis of 31 patients aged 5 to 73 years (17 females), with 40 cysts, operated between 2006 and 2009. All patients received albendazol for 15 days prior to surgery and for 2 months afterwards. Surgical technique consisted in the evacuation of parasite membrane, partial excision of prominent pericystic membrane and suture of biliary communications. Results: Sixty nine percent of cysts were uni-vesicular, 74% were unique and 68% were located in the right lobe. Surgical time was 80 min. Two patients were converted to open surgery and 24% had postoperative complications. Mean hospital stay was six days. Patients were followed for 28 months and in 4% the cyst relapsed. No patient died. The mean cost of laparoscopic treatment was US$ 2.107. Conclusions: Laparoscopic technique is a useful surgical alternative for the treatment of liver hydatid cysts
External biliary fi stula after surgery for hydatid cysts. Retrospective analysis of 58 patientsBackground: External biliary fi stula is the most common complication of surgery for liver hydatid cysts. Aim: To report the experience with the conservative management of external biliary fi stula. Material and Methods: Retrospective analysis of medical records of patients operated for hydatid cysts, complicated with external biliary fi stula, between 1985 and 2004. Results: In the study period, 554 patients were operated for liver hydatid cysts and in 58 (10.5%), an external biliary fi stula appeared. In 90% of these patients, cysts were located in the right lobe and 30% were multiple cysts. Seventy seven percent of cysts were multivesicular, 10% were infected and 52% had a concealed cysto-biliary rupture. In 84% of patients, a conservative surgical approach such as marsupialization and partial excision of the peri cystic region was used. Mean hospital stay of these patients was 36.8 days, compared with 11.4 days among patients without fi stulae. Conclusions: Among patients that require surgery for hydatid cysts, risk factors for biliary fi stula should be sought and conservative surgical approaches should be avoided whenever possible Key words: Hydatid cyst, biliary fi stula, surgery. ResumenLa fístula biliar externa (FBE) es la complicación más frecuente en la cirugía del quiste hidatídico hepático (QHH). En esta oportunidad se quiere dar a conocer la experiencia en el manejo conservador de la fístula biliar secundaria a la cirugía del QHH. Se revisa en forma retrospectiva los registros clínicos de 554 pacientes tratados por hidatidosis hepática, desde enero 1985 a diciembre de 2004, en el Servicio de Cirugía del Hospital Regional de Coyhaique. De acuerdo a los hallazgos clínicos preoperatorios, estudio de imágenes, hallazgos operatorios y seguimiento de los pacientes, se encontraron 58 pacientes (10,5%) portadores de fístula biliar postoperatoria. En los 554 pacientes tratados durante este período, se encontró 91 con fi ltración biliar (16,4%) y en 58 (10,5%) se constató la presencia de FBE. Los hallazgos anatomopatológicos indicaron que el 76,6% de los quistes eran multivesiculares, que sólo el 10% estaba infectado y que la ruptura cistobiliar oculta estaba presente en el 51,7% de los casos. Las técnicas quirúrgicas conservadoras fueron las más utili-Rev.
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