Minimally Invasive Treatment of Liver Hydatidosis

Abstract

Background and Objectives:Open surgery has been the mainstay treatment for liver hydatidosis in the past. Today, for treatment of simple and uncomplicated cysts, we have a variety of choices: antihelmintic therapy, the PAIR (puncture, aspiration, injection, and respiration) technique, and the laparoscopic approach. We reviewed our series of 267 cases of hepatic hydatidosis submitted to surgery over a period of 20 years, from 1995 through 2014, comparing the results of these minimally invasive treatments.Methods:In 92 patients (25.7% of cases) who presented with complicated liver hydatid cysts, we performed open surgery. In 16.4% of cases (59 patients), we used a laparoscopic approach, and in 208 patients (57.9% of cases), we used the PAIR technique. All patients were monitored after surgery for a mean of 61.7 months (range, 16–127). Postoperative follow-up consisted of clinical examination, laboratory investigation, abdominal ultrasound, and magnetic resonance imaging.Results:Almost all patients (198, 95.2%) treated with the PAIR technique and 55 patients (93.2%) treated with the laparoscopic approach were cured. Six patients (2.8%) from the echo-guided puncture group had to undergo a repeat of the procedure because the cavity did not disappear after 2 years. In 4 patients (2%), we performed open surgery for 2 biliary fistulas and 2 hepatic abscesses. Four patients from the laparoscopic group needed additional procedures. Open surgery was necessary in 2 patients for a recurrence after 2 years; 1 patient had developed a liver abscess and the other had a biliary fistula.Conclusions:In conclusion, open surgery remains the viable option for complicated cysts, with biliary communication, with multiple daughter vesicles, or with calcified walls. For simple, uncomplicated hydatid cysts, both methods (the PAIR technique and laparoscopic procedure) are safe and efficient, with very good results and low morbidity rates.

Comparative study of laparoscopic and open surgery in management of 50 cases of liver hydatid cyst

“…Group B had less burden in term of money and time of patient as well as hospital management. 11,12 In this study, authors had seen anaphylactic shock in 1 case in the Group A. Patient was managed by intravenous steroid and inj.…”

Clinical profile and surgical outcome of abdominal hydatid cyst at a university hospital in Nepal

“…[15][16][17] and laparoscopic management are other good option, increasingly becoming popular as a safe and effective modality. [18][19][20][21][22] In all cases of surgical management, care must be taken not to spill the cyst fluid to prevent anaphylaxis, and use of appropriate scolicidal agent is important to deactivate the live scolices to prevent the dissemination of disease. 21,23 In recent years, we have shifted from the historical use of 1% silver nitrate solution to 10% povidone iodine solution at our hospital.…”

Laparoscopic treatment of hepatic hydatid disease: Şanlıurfa-Turkey experience and early clinical outcomes

“…Minimal invasive techniques such as percutaneous drainage procedures and laparoscopic approaches have started to replace the classical surgical approaches. [3,4] Laparoscopic treatment was first described in 1992, and in recent years there has been a steady growth especially in the laparoscopic approach. The technique chosen is either PAIR (percutaneous, aspiration, injection and re-aspiration) or laparoscopic surgery; the main purpose of the treatment is to prevent cystic inactivation and spread of cystic content into the abdomen like the conventional open cyst hydatid surgery in addition to the clearance of the cystic content and minimization of the cyst cavity.…”