Surgical management of hepatic hydatid cysts – conservative versus radical surgery

Deo, Kunal Bikram; Kumar, Rahul; Tiwari, Govinda; Kumar, Hemanth; Verma, Geetika; Singh, Harjeet

doi:10.1016/j.hpb.2020.03.003

Cited by 28 publications

(25 citation statements)

References 26 publications

(45 reference statements)

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“…Roux limb: 40 cm distal to duodeno-jejunal flexure, jejunal loop divided, and mobilized through the transverse mesocolon up to the cystic cavity. The mobilized jejunal limb sutured (cysto-jejunostomy) to the cystic margin (single-layered, hand sewn, interrupted) using vicryl 4-0 (c) leak and the need for endoscopic biliary stenting in radical surgery group [5]. In our case, we initially approached with omentoplasty and capitonnage with external tube drainage.…”

Section: Discussionmentioning

confidence: 97%

Roux En Y drainage of a large hepatic hydatid cyst as treatment for recalcitrant bile leak: a case report

et al. 2020

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Background Hydatid disease is relatively uncommon in children and thus rarely reported in literature. Pediatric patients with large hydatid cysts can have grave complications due to mass effect. Postoperative bile leak is the most common morbidity and continues to be a challenge for the treating surgeon. Case presentation A 7-year-old boy diagnosed with a giant hydatid cyst of the liver, almost replacing the right lobe, and underwent a laparotomy and excision of cyst with tube drainage. He developed postoperative major bile leak which did not subside even after a redo laparotomy and closure of the suspected bile leak areas. The child underwent a third laparotomy after a hepatobiliary scintigraphy (HIDA scan) which confirmed a persisting major leak. A Roux En Y cystojejunostomy was done this time which drained the bile adequately postoperatively with no evidence of bile in the subhepatic drain. Oral feeds were resumed on the fifth postoperative day. He was discharged in a satisfactory condition and is doing well in the follow-up. Repeat HIDA scan showed no evidence of spillage, with adequate bilio-enteric drainage. Conclusion Persistent major bile leak requiring ERCP with sphincterotomy can be managed successfully in children by internal drainage as Roux En Y cystojejunostomy.

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Section: Discussionmentioning

confidence: 97%

Roux En Y drainage of a large hepatic hydatid cyst as treatment for recalcitrant bile leak: a case report

et al. 2020

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“…Before anthelmintic agents were introduced, surgery was the treatment of choice in patients with hepatic CE. Despite the low morbidity and mortality, radical surgeries might not be applicable in all cases [ 31 – 33 ]. These drawbacks have forced physicians to introduce less harmful and more accurate treatment options.…”

Section: Discussionmentioning

confidence: 99%

Endocystectomy as a conservative surgical treatment for hepatic cystic echinococcosis: A systematic review with single-arm meta-analysis

et al. 2021

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Background In patients with hepatic cystic echinococcosis (CE), treatment effectiveness, outcomes, complications, and recurrence rate are controversial. Endocystectomy is a conservative surgical approach that adequately removes cyst contents without loss of parenchyma. This conservative procedure has been modified in several ways to prevent complications and to improve surgical outcomes. This systematic review aimed to evaluate the intraoperative and postoperative complications of endocysectomy for hepatic CE as well as the hepatic CE recurrence rate following endocystectomy. Methods A systematic search was made for all studies reporting endocystectomy to manage hepatic CE in PubMed, Web of Science, and Cochrane CENTRAL databases. Study quality was assessed using the methodological index for non-randomized studies (MINORS) criteria and the Cochrane revised tool to assess risk of bias in randomized trials (RoB2). The random-effects model was used for meta-analysis and the arscine-transformed proportions were used to determine complication-, mortality-, and recurrence rates. This study is registered with PROSPERO (number CRD42020181732). Results Of 3,930 retrieved articles, 54 studies reporting on 4,058 patients were included. Among studies reporting preoperative anthelmintic treatment (31 studies), albendazole was administered in all of them. Complications were reported in 19.4% (95% CI: 15.9–23.2; I2 = 84%; p-value <0.001) of the patients; biliary leakage (10.1%; 95% CI: 7.5–13.1; I2 = 81%; p-value <0.001) and wound infection (6.6%; 95% CI: 4.6–9; I2 = 27%; p-value = 0.17) were the most common complications. The post-endocystectomy mortality rate was 1.2% (95% CI: 0.8–1.8; I2 = 21%; p-value = 0.15) and the recurrence rate was 4.8% (95% CI: 3.1–6.8; I2 = 87%; p-value <0.001). Thirty-nine studies (88.7%) had a mean follow-up of more than one year after endocystectomy, and only 14 studies (31.8%) had a follow-up of more than five years. Conclusion Endocystectomy is a conservative and feasible surgical approach. Despite previous disencouraging experiences, our results suggest that endocystectomy is associated with low mortality and recurrence.

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“…To date, the surgical treatment techniques used for liver hydatid cyst have been based on 2 main principles: the first being a total cystectomy or a form of liver resection, in which the whole cyst is excised; and the other being partial cystectomy and cavity draining techniques, in which the cyst is partially excised. Total excision of the cyst is usually not preferred by surgeons due to the location of the cyst, the surgeon's lack of experience, and the associated high mortality and morbidity [ 14 15 16 ]. In our clinical practice, we perform total or near-total cystectomy for peripherally located cysts in segments 2, 3, 5, and 6.…”

Section: Discussionmentioning

confidence: 99%

“…The morbidity and mortality outcomes of all cases that were operated on with this technique are much lower when compared to those undergoing resection and drainage techniques mentioned in the literature [ 15 16 ]. The development of biliary leak is one of the most frightening complications whether with radical surgical techniques or drainage techniques [ 12 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…The development of biliary leak is one of the most frightening complications whether with radical surgical techniques or drainage techniques [ 12 17 ]. Recently, Deo et al [ 16 ] reported 7.4% biliary leak rates for resection procedures and 27% for conservative procedures. One biliary leak (8.3%) was developed in a case of our series having 3 cysts and 5 biliary fistulas in cyst cavities.…”

Section: Discussionmentioning

confidence: 99%

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The usefulness of drainage-internal capitonnage with/without selective bile duct repair technique for liver hydatid cyst

et al. 2021

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Purpose The aim of the present study is to describe the cavity-reducing internal capitonnage technique that we used for the surgical therapy of liver hydatid cyst, and contribute to the literature by presenting the short- and long-term outcomes of the patients who were operated on with this technique. Methods A drainage and internal capitonnage technique was performed on 12 cases due to liver hydatid cyst in our clinic between January 2016 and December 2019. Results The mean age of cases was 36.25 ± 12.5 years, with 7 females and 5 males. All cases had pain in the right upper quadrant, and a sense of fullness in 5 cases. None of the cases had ruptured cysts, jaundice, or other clinical manifestations. The preoperative laboratory findings were normal in 8 cases. Intraoperative biliary-cyst communication was demonstrated in 8 cases (66.7%). Cases were followed up for a mean duration of 38.1 months (range, 24–88 months). Conclusion The drainage/internal capitonnage with/without selective bile duct repair is a technique that can be performed with very low morbidity and mortality rates in experienced hands, especially for centrally located hydatid cysts.

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Surgical management of hepatic hydatid cysts – conservative versus radical surgery

Cited by 28 publications

References 26 publications

Roux En Y drainage of a large hepatic hydatid cyst as treatment for recalcitrant bile leak: a case report

Roux En Y drainage of a large hepatic hydatid cyst as treatment for recalcitrant bile leak: a case report

Endocystectomy as a conservative surgical treatment for hepatic cystic echinococcosis: A systematic review with single-arm meta-analysis

The usefulness of drainage-internal capitonnage with/without selective bile duct repair technique for liver hydatid cyst

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