Combined Resection of the Liver and the Inferior Vena Cava for Hydatid Disease

Mekeel, Kristin L.; Hemming, Alan W.

doi:10.1007/s11605-007-0292-y

Cited by 15 publications

(17 citation statements)

References 8 publications

(5 reference statements)

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“…7,9,10 In contrast, the North American experience with hydatid disease remains extremely limited owing to the rarity of this pathology and is restricted to rare series and occasional case reports. 8,11 To our knowledge, the present series represents the largest combined surgical experience with hydatid disease of the liver in North America. Although the sample size presented in this work is small in comparison to large series from endemic areas, it is nevertheless highly important, as it portrays the work of trained liver surgeons with a wealth of experience in resective oncologic liver surgery but with limited experience with liver infestations.…”

Section: Discussionmentioning

confidence: 88%

“…[3][4][5][6] In contrast, liver surgeons working in Western centres -particularly North American hospitals -can be expected to treat only a handful of such patients over the course of their careers. [7][8][9][10][11] In this context, it becomes particularly important to define surgical treatment strategies that are specific to the expertise of Western liver surgeons, which is lacking in the literature. We sought to review a single North American tertiary care centre's experience with patients who underwent liver surgery for hydatid cysts of the liver.…”

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confidence: 99%

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Surgical management of symptomatic hydatid liver disease: experience from a Western centre

et al. 2014

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Background: Hydatid liver cysts are rare in North America. The objective of this study was to determine the optimal surgical management for hydatid liver cysts treated outside endemic areas. Methods:We reviewed the cases of consecutive patients who underwent management of hydatid liver cysts. Radical liver resections were compared with other types of procedures. Clinical presentation, investigations, perioperative outcomes and longterm follow-up were evaluated. We evaluated disease recurrence using the KaplanMeier method.Results: Forty patients underwent surgery for hydatid liver cysts. Most patients had single (68%) right-sided (46%) cysts with a median size of 10 cm. Most (83%) underwent liver resection with or without drainage/marsupialization. Radical liver resection was carried out in 60% (19 major, 5 minor). Additional procedures were required in 50% (biliary fistulization 30%, diaphragmatic fistulization 20% or paracaval location/ fusion 8%). Postoperative complications occurred in 48%. The median follow-up was 39 months. The 3-year recurrence-free survival was significantly different between patients who had radical resection and those who had other procedures (100% v. 71%, p = 0.002). Conclusion:The surgical management of hydatid liver cysts in North America remains rare and challenging and is frequently associated with fistulizing complications. Excellent long-term outcomes are best achieved using principles of radical liver resection that are familiar to North American surgeons.Contexte : L'hydatidose (kyste hydatique du foie) est une affection rare en Amérique du Nord. Cette étude visait à déterminer quelle était la meilleure façon de prendre en charge cette maladie à l'extérieur de zones où elle est endémique. Méthodes :On a revu les cas de patients consécutifs traités pour des kystes hydatiques du foie. L'ablation radicale du foie a été comparée à d'autres types d'intervention. Le tableau clinique, les examens exploratoires, les résultats périopéra-toires et le suivi de longue durée ont été évalués. On a aussi évalué la récurrence de la maladie en utilisant la méthode Kaplan-Meier.Résultats : Quarante patients avaient été opérés pour des kystes hydatiques du foie. La plupart présentaient des kystes simples (68 %) dans le foie droit (46 %), qui mesuraient en moyenne 10 cm de diamètre. La plupart (83 %) avaient subi une résection hépatique avec ou sans drainage ou marsupialisation. Une résection radicale a été pratiquée chez 60 % des patients (19 cas majeurs, 5 cas mineurs). D'autres interventions se sont avérées nécessaires dans 50 % des cas (fistulisation dans les voies biliaires 30 %, fistulisation dans le diaphragme 20 %, localisation paracave ou fusion 8 %). Des complications postopératoires sont survenues dans 48 % des cas. La durée moyenne du suivi a été de 39 mois. On a observé une différence significative entre le taux de survie sans récidive sur 3 ans entre les patients ayant subi une résection radicale et ceux ayant subi une autre intervention (100 % c. 71 %, p = 0.002). Conclusion :En Amé...

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Section: Discussionmentioning

confidence: 88%

mentioning

confidence: 99%

Surgical management of symptomatic hydatid liver disease: experience from a Western centre

et al. 2014

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“…In our series, this was the main contraindication for RS. A small number of combined resections of the inferior vena cava and hydatid cyst have been reported [21] , but we believe that this procedure should be performed only in cases of serious complications (Budd-Chiari syndrome, hemorrhage or other) that justify exeresis.…”

Section: Discussionmentioning

confidence: 99%

“…Few publications exist on patients treated exclusively by RS (22). The percentage of RS in mixed series varies widely and ranges from 15% to 80% [1][2][3][4][5][6][7][8][9][10][11][12][13][14][17][18][19][20][21] , but a few series have reported as many as 75% of patients treated with RS, including our series [11,17,22] . The use of an ultrasonic bisturi, a more refined hepatic surgery technique, to treat patients with HDL in hepato-bilio-pancreatic units that have experience in treating this condition, and the surgical team's awareness of the advantages of RS, are the key to attaining this RS rate, with CS being restricted to very specific cases [23] .…”

Section: Discussionmentioning

confidence: 99%

Ambispective comparative study of two surgical strategies for liver hydatidosis

Ramia

Ruiz-Gomez²,

Plaza³

et al. 2012

WJG

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AIM:To investigate the morbidity, mortality, recurrence and technical aspects of two distinct surgical strategies that were implemented in successive periods. METHODS:Ninty-two patients with 113 cysts underwent surgical procedures. The study was divided into 2 periods. Data from first period (P1) were compiled retrospectively. The surgical strategy was conservative surgery. The second period (P2) included a prospective study conducted according to a protocol following the criterion that radical procedures should be performed whenever it is technically feasible. RESULTS:Patients of both periods showed no statistically significant differences in age, gender, cyst location or mortality. Among the P2 group, patients exhibited more preoperative jaundice, and cyst size was smaller (P < 0.05). Changes in surgical strategy increased the rate of radical surgery, decreases morbidity and in-hospital stay (P < 0.001). A negative result in P2 was the death of two old patients (4.8%) who had undergone conservative treatments. The rate of radical surgery in P2 was around 75%. CONCLUSION:Radical surgery should be the technique of choice whenever it is feasible, because it diminishes morbidity and in-hospital stay. Conservative surgery must be employed only in selected cases.

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“…1 They state that they do not believe the patients' symptoms can be attributed to portal hypertension and believe that lifelong anticoagulation is required for a Gortex graft placed in the retrohepatic, suprarenal position. They also state that they believe the cyst must have had a low intracystic pressure since it was old and calcified.…”

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confidence: 99%

Is Vena Cava Resection Justified for Hydatid Liver Cyst. Reply

Hemming

Mekeel

2008

Journal of Gastrointestinal Surgery

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In their letter, Dr. Kayaalp et al. take issue with the management described in a case report of hydatid disease that resulted in inferior vena cava (IVC) and hepatic vein obstruction and stenosis with subsequent portal venous hypertension. 1 They state that they do not believe the patients' symptoms can be attributed to portal hypertension and believe that lifelong anticoagulation is required for a Gortex graft placed in the retrohepatic, suprarenal position. They also state that they believe the cyst must have had a low intracystic pressure since it was old and calcified. As a general comment, we would state that the requirement for resection of the IVC for hydatid disease should be incredibly rare, hence our belief that the case report might be of interest.At the operative procedure, it was clear that there was a tremendous inflammatory response to the cyst that might explain the symptoms. In our case report, we did not state that the patient had any symptoms related to portal hypertension, only symptoms of pain and shortness of breath, which we would assume most people know are not symptoms of portal hypertension. While we did not measure intracystic pressures, on opening the cyst, the contents appeared to be under relatively high pressure. We, in fact, initially believed that simply reducing the pressure by decompressing what appeared to be a high-pressure hydatid cyst might relieve the hepatic venous outflow obstruction and relieve the portal venous hypertension. When this did not occur, we believed that shunting of total IVC flow through the large inferior hepatic vein across the liver and out a stenotic left hepatic vein that was unable to accommodate the high flow of combined portal and caval flows was the cause of the portal venous hypertension. Resecting the cyst/liver effectively removed the source of inflammation, interrupted the collaterals through the liver, and replaced the completely occluded IVC. It allowed reduction of flow through the only remaining hepatic vein and relieved the portal hypertension. We felt that leaving a correctable form of portal hypertension uncorrected at operation would be inappropriate. We have reported previously on a moderately large series of combined liver and IVC resections for malignancy. 2 Current combined liver and IVC resections, including malignant and nonmalignant cases, at our institution now number over 30 cases. All grafts are patent with follow-up from 3 months to 8 years, and no patients with a Gortex ring graft have been placed on any anticoagulation after their procedure apart from a daily baby aspirin. There is no evidence that lifelong anticoagulation is required for Gortex grafts placed in the retrohepatic suprarenal position. After the surgery, the patient was symptom-free for the first time in over 3 years, has returned to work for the first time in 2 years and has a patent graft on no anticoagulation. Since both symptoms and portal hypertension are gone and the patient is not on anticoagulation, we feel we made an appropriate choice. References 1....

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Combined Resection of the Liver and the Inferior Vena Cava for Hydatid Disease

Cited by 15 publications

References 8 publications

Surgical management of symptomatic hydatid liver disease: experience from a Western centre

Surgical management of symptomatic hydatid liver disease: experience from a Western centre

Ambispective comparative study of two surgical strategies for liver hydatidosis

Is Vena Cava Resection Justified for Hydatid Liver Cyst. Reply

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