Laparoscopic treatment of hydatid cyst of the liver in children. A report on 34 cases

Pediatric Echinococcosis of the Liver in Austria: Clinical and Therapeutical Considerations

Echinococcosis is considered a neglected disease in most European countries. However, migratory flows of populations, long-term stays in endemic areas, uninterrupted tourism (travel to Echinococcus-endemic countries), traveling dogs and dog translocations from endemic areas, and inappropriate hygiene practices are potential factors that alarm public health officials. Identifying a cyst-like mass in the liver or lung of an individual with a travel history of likely exposure to sheepdogs in an area where the parasite Echinococcus (E.) granulosus (sive cysticus) is endemic advocates for a prompt preliminary diagnosis of cystic echinococcosis (CE), no matter the age of the affected individuals. Routine imaging techniques, including ultrasonography, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans, are used to detect cysts. After a cyst has been discovered, serologic investigations are used to confirm the diagnosis. Typically, alveolar echinococcosis (AE) is found in older individuals. Yet young people are also affected because frequent oral exploration of the environment is a regular behavior for infants and toddlers. In this review, therapeutic considerations for pediatric echinococcosis-drug-based benzimidazole therapy; AE: atypical liver resection, the resection of individual or multiple segments, a right or left hemi-hepatectomy, or an extended hemi-hepatectomy; CE: PAIR-technique, cyst excision, liver segment(s) resection (laparoscopically or conventionally)-are revised following experience in one of the most affected regions of Europe. In addition, we performed a systematic review using three databases (i.e., PubMed, EMBASE, and Scopus) to evaluate the quality of evidence in published studies on pediatric echinococcosis.

Comparison of laparoscopic and open surgery in hepatic hydatid disease in children: Feasibility, efficacy and safety

Background:

Surgery continues to be the mainstay of treatment of hydatid cysts of the liver. Laparoscopy provides a lesser invasive tool for achieving results same as with the established open surgical techniques. The purpose of the study was to evaluate the feasibility and safety of laparoscopic management of hepatic hydatid disease in children.

Patients and Methods:

It was a prospective randomised study conducted over a period of 7 years. Children with Gharbi Type I, II, III cysts, ≤3 cysts and superficial accessible cysts were treated laparoscopically and their outcomes were compared with matched controls treated by open approach.

Results:

Sixty patients were included in the study with thirty patients in each matched group. Thirty paediatric patients (male 12:female 18) with 35 liver hydatid cysts underwent laparoscopic surgery. The mean cyst size was 8.8 ± 2.39 cm. Two patients needed conversion to open. No significant spillage of cyst contents was observed in any of the patients. Duration of hospital stay, time to removal of drains, duration of parenteral analgesia, severity of pain in postoperative period, time to ambulation and time to return to full orals were significantly lower in laparoscopic group compared to open group. Complication rates in both the groups were similar.

Conclusion:

With proper patient selection, laparoscopic management of hydatid cysts of the liver in children is feasible and safe option with low morbidity, low rates of conversion and minimal complications.

Thoracoscopic Transdiaphragmatic Excision of Hepatic Hydatid in Patients with Synchronous Pulmonary Hydatid: A Novel Operative Approach

Background: We wish to describe a novel technique of transdiaphragmatic excision of hepatic hydatid in patients with synchronous ipsilateral lung hydatid. Patients and Methods: Two patients, aged 11 and 6 years, presented with large synchronous hydatid cyst in right lung and liver. Second patient had two large cysts in right lobe of liver in posterior-superior segment of VII and VIII. The patients underwent thoracoscopic excision of lung cyst, and in same sitting the liver hydatid was seen bulging through the diaphragm. The diaphragm was incised to expose the cyst beneath, with excision of hydatid. Port-in-cyst technique was used to excise the membranes. Results: Both lung and liver cyst were successfully removed through thoracoscopic approach and a laparotomy was altogether avoided. Both patients did well in follow-up (3 years and 6 months). There are no respiratory issues in these patients. Conclusions: This is a novel approach for multiple synchronous hepatic and pulmonary hydatid. This can be applied in specific scenario as described. It gives a significant advantage of avoiding a laparotomy and thoracotomy in patients and thus reducing morbidity.

Successful robotic radical resection of hepatic echinococcosis located in posterosuperior liver segments

BACKGROUND

Radical resection is an important treatment method for hepatic echinococcosis. The posterosuperior segments of the liver remain the most challenging region for laparoscopic or robotic hepatectomy.

AIM

To demonstrate the safety and preliminary experience of robotic radical resection of cystic and alveolar echinococcosis in posterosuperior liver segments.

METHODS

A retrospective analysis was conducted on the clinical data of 5 patients with a median age of 37 years (21-56 years) with cystic and alveolar echinococcosis in difficult liver lesions admitted to two centers from September to December 2019. The surgical methods included total pericystectomy, segmental hepatectomy, or hemihepatectomy.

RESULTS

Among the 5 patients, 4 presented with cystic echinococcosis and 1 presented with alveolar echinococcosis, all of whom underwent robotic radical operation successfully without conversion to laparotomy. Total caudate lobectomy was performed in 2 cases, hepatectomy of segment VII in 1 case, total pericystectomy of segment VIII in 1 case, and right hemihepatectomy in 1 case. Operation time was 225 min (175-300 min); blood loss was 100 mL (50-600 mL); and postoperative hospital stay duration was 10 d (5-19 d). The Clavien-Dindo complication grade was I in 4 cases and II in 1 case. No recurrence of echinococcosis was found in any patient at the 3 mo of follow-up.

CONCLUSION

Robotic radical surgery for cystic and selected alveolar echinococcosis in posterosuperior liver segments is safe and feasible.

A systematic review and meta-analysis on the treatment of liver hydatid cyst using meta-MUMS tool: comparing PAIR and laparoscopic procedures

INTRODUCTION

There is an academic debate over surgical treatments of liver hydatid cyst disease. In this study, a systematic review and meta-analysis were carried out in order to evaluate the pros and cons of both PAIR (Puncture, Aspiration, Injection, Respiration) and laparoscopic techniques by considering the outcomes of liver hydatid cysts.

MATERIAL AND METHODS

We designed descriptive Boolean queries to search two databases, PubMed and Scopus, to derive the articles published in the period of January 2000 to December 2016 in order to evaluate the outcomes of these research articles. The outcomes of laparoscopic and PAIR procedures include the rates of cure, postoperative complications, recurrences, and mortality, which were extracted, assessed, and used as their corresponding effect sizes.

RESULTS

Fifty-seven studies including a total of 2832 patients (PAIR group n = 1650 and laparoscopic group = 1182) were analyzed. In this meta-analysis study, a random effect model of correlations of outcomes (postoperative complications, mortalities, recurrences, and cure rates) of PAIR and laparoscopy procedures was used. The meta-analysis and the forest plots of the two procedures show that the PAIR approach is superior in terms of cure, complication, and mortality rates compared with the laparoscopy technique. However, the recurrence rate is low in laparoscopic approaches. Moreover, Egger's tests for determining publication bias and heterogeneity tests were also performed.

CONCLUSIONS

This study shows promising trends toward an advantage of PAIR procedures in treatment of liver hydatid cyst in comparison with laparoscopic procedures. The PAIR procedure is superior to laparoscopy due to having a higher cure rate and lower complication and mortality rates; however, the latter has a lower recurrence rate.

Laparoscopic Treatment in Children with Hydatid Cyst of the Liver

BACKGROUND

There is no consensus on the surgical treatment of children with hydatid cyst of the liver (HCL). We evaluated the outcomes of laparoscopic and open surgery for childhood HCL.

METHODS

We performed 81 open surgery and laparoscopic procedures in 37 (45.7%) boys and 44 (54.3%) girls with HCL (mean age 9.3 ± 2.1 years) who were assigned to a main group (laparoscopy, n = 21) and a control group (open surgery, n = 60). Clinical assessments, surgical durations, complications, and postoperative outcomes were investigated. Cyst types in the two groups were I (Gharbi)/CE 1 (WHO-IWGE), 71.4 and 58.3%, respectively; II/CE 2, 19.1 and 25.0%, respectively; and III/CE 3, 9.5 and 16.7%, respectively. The parasitic hydatid cysts were located mostly in the right liver lobe in both the main and control groups (90.4 and 80.0%, respectively).

RESULTS

Hospital stays were significantly (p < 0.05) longer in patients in the control group (12.1 ± 1.5 vs. 5.6 ± 2.2 days). Operation time was significantly (p < 0.01) shorter for the main group (90.1 ± 7.8 vs. 120.6 ± 5.3 min). Local complications (residual cavity infection, biliary fistula) occurred in 21.6% of patients in the control group and 14.3% in the main group. Each was treated, and none recurred. There were no apparent systemic complications.

CONCLUSIONS

Laparoscopic surgical treatment for children with HCL is safe in compliance with all classic open surgery principles. The laparoscopic technique offered a shorter duration of the surgical effects and markedly fewer postoperative complications.

World review of laparoscopic treatment of liver cystic echinococcosis--914 patients

OBJECTIVE

The aim of this study was to provide a review of the world literature on the laparoscopic treatment of liver hydatid cyst.

METHODS

We conducted a literature search using PubMed, screening all English language publications on the laparoscopic treatment of liver hydatid cysts. Operative characteristics, perioperative morbidity, and clinical outcomes were tabulated.

RESULTS

A total of 57 published articles including 914 patients with 1116 hydatid cysts were identified. Of the resections done in the 914 patients, 89.17% were performed totally laparoscopically and 5.58% were gasless. The most common procedure was cystectomy (60.39%), followed by partial pericystectomy (14.77%) and pericystectomy (8.21%); the rest were segmentectomies. Conversion to open laparotomy occurred in 4.92% of reported cases (45/914). The common cause of conversion was anatomical limitations/inaccessible locations (16/45). The overall mortality was 0.22% (2/914 patients) and morbidity was 15.07%, with no intraoperative deaths reported. The most common complication was bile leakage (57/914). The postoperative recurrence was 1.09% (10/914 patients).

CONCLUSIONS

The laparoscopic approach is safe with acceptable mortality and morbidity for both conservative and radical resections in selected patients. Clinical outcomes are comparable to open surgery, albeit in a selected group of patients.

A simplified protocol of combined thoracoscopy and laparoscopic excision for large subdiaphragmatic hepatic hydatid cysts

Human hydatid disease caused by echinococcus granulosus is one of the commonest zoonosis and it primarily affects the liver. Amongst, the various treatment options, surgical management with removal of its contents and pericystectomy under the cover of anti-helminthic is the treatment of choice. Large hydatid cysts located in the posterosuperior aspect of liver often require thoracic approach. In this context, we describe an innovative combined thoraco-laparoscopic technique for the surgical treatment of large subdiaphragmatic hepatic hydatid cyst.

Laparoscopic port-in-cyst technique for retrieval of hepatic hydatid and review of other techniques used in literature

AIM

To describe a technique used for removal of hepatic hydatid cyst laparoscopically.

PATIENTS AND METHODS

The removal of hydatid membranes was achieved by inserting a 10-mm port right above the cyst. The port is made to enter the cyst, and the membranes are removed without any contact to outer surface, thus avoiding peritoneal spillage.

RESULTS

The technique was used in 6 patients. Mean age was 3.5 years, range being. 2.5 to 6 years. Three patients had solitary cyst in the right lobe, and 2, in left lobe. One had multiple cyst involving both right and left lobes. Follow-up is of mean 6 months. There is no recurrence or evidence of new cyst owing to peritoneal seeding.

CONCLUSIONS

Safe extraction of hydatid membranes during laparoscopy can be done by directly placing the port within the decompressed cyst and removing the membranes with minimal use of suction. The port-in-cyst technique excludes any possibility of peritoneal seeding, during hydatid removal which may lead to metachronous recurrence in the peritoneum.

Vest-over-Pant Method for Closure of Residual Cavity of Liver Hydatid Cyst

Objective. Although several therapeutic strategies have proven to be effective for hydatid cyst of liver, but surgery is still the most common therapy despite its morbidity and mortality. Furthermore, a variety of technique has been recommended for managing the residual cavity after cystectomy. We report here a new technical method for the reconstruction of hydatid cyst residual cavity with using overlapping flaps of liver edges (Vest over Pant). Methods. In this technique after removing the cyst, the edges of one side of cyst cavity were sutured to the base of the cavity using three to four mattress sutures), and edges of other side of liver was overlapped on the dorsal part of previous layer using four to five mattress sutures. Therefore residual cavity dead space was obliterated with two surfaces of cavity. Results. Fifty males were treated by our method. The average cyst volume was 423 ± 110 mL. There was no intraabdominal sepsis, bile leakage, or hepatic necrosis. In follow-up ultrasound study, residual cavities were disappeared one month after operation. Conclusion. Overlapping flaps of liver edges (Vest over Pant) provides easy, safe closure of cyst with preservation of the liver anatomy.

Giant primary adrenal hydatid cyst presenting with arterial hypertension: a case report and review of the literature

Introduction

A primary hydatid cyst of the adrenal gland is still an exceptional localization. The adrenal gland is an uncommon site even in Morocco, where echinococcal disease is endemic.

Case presentation

We report the case of a 64-year-old Moroccan man who presented with the unusual symptom of arterial hypertension associated with left flank pain. Computed tomography showed a cystic mass of his left adrenal gland with daughter cysts filing the lesion (Type III). Despite his negative serology tests, the diagnosis of a hydatid cyst was confirmed on surgical examination. Our patient underwent surgical excision of his left adrenal gland with normalization of blood pressure. No recurrence has occurred after 36 months of follow-up.

Conclusion

There are two remarkable characteristics of this case report; the first is the unusual location of the cyst, the second is the association of an adrenal hydatid cyst with arterial hypertension, which has rarely been reported in the literature.

Laparoscopic treatment of liver diseases in children

Laparoscopic liver surgery has been increasingly used for the treatment of pediatric liver diseases over the past decade due to the development of special laparoscopic instruments and improvements in the technique. A number of factors are considered when electing to undergo the surgical process, including age, type of liver disease, and so on. Especially in children with liver masses, the number of trocars used and the position of their placement must be carefully designed to achieve successful outcomes. In the current review, the application of various laparoscopic instruments and the methods used for the laparoscopic treatment of liver diseases in children over the past decade are summarized.

Minimal access surgery for multiorgan hydatid cysts

Multiorgan hydatid cysts caused by larval growth of Echinococcus granulosus, is a rare condition in paediatric age group. There are very few reports of management of multiorgan hydatid cysts, involving lung, liver, and spleen by minimally invasive approach in paediatric age group. Herewith, we are reporting a case of hydatid cysts involving lung, liver, and spleen in a six-year-old child managed by minimally invasive surgery along with the review of literature.

Complications of extrahepatic echinococcosis: Fistulization of an adrenal hydatid cyst into the intestine

Echinococcal cysts are usually found in liver and lungs, but any other organ can potentially be involved. Extrahepatic disease due to hydatid cyst may develop in the abdominal and pelvic cavity, aside from in other less common locations, which may make both diagnosis and treatment more complex. We present a rare case of extrahepatic echinococcosis in a 70-year old patient with a 4-d history of dull abdominal pain, anemia within the transfusion range and fever. She underwent surgery for left renal hydatid cysts 30 years ago. After non operative treatment, imaging studies showed a calcified hydatid cyst in a retrogastric location communicating with a proximal jejunal loop. En-block resection of the mass together with the adrenal gland was performed including closure of the enteric fistula. Anatomic pathology confirmed the diagnosis of a calcified hydatid cyst of left adrenal origin. Surgery is the treatment of choice and most authors recommend removal of cyst and adrenal gland.