Management of patients with endometriosis and infertility: laparoscopic treatment and spontaneous pregnancy rate

OBJECTIVE

To evaluate factors involved in spontaneous pregnancy rate after surgery for endometriosis in patients with endometriosis and infertility.

METHODS

This retrospective study spanned from 2014 to 2020 and included a follow-up period of two years of patients with endometriosis-related infertility who underwent laparoscopic surgery. Women aged 25 to 43 years with patent tubes, no/mild male factor and no other infertility factors were selected and grouped according to fertility management as follows: patients immediately prescribed ART (16.5%, ART-p); patients who chose not to undergo ART (83.5%) and achieved spontaneous pregnancy (71.8% SP-p); and patients who first chose not to undergo ART but had it subsequently (28.2%, NSP-p).

RESULTS

A total of 200 patients were analyzed. Of the 167 patients who waited for spontaneous pregnancy, 71.8% achieved it. We observed a tendency of higher endometriosis ASRM scores in the ART-p group compared with patients who waited for spontaneous pregnancy, and lower scores in individuals that achieved spontaneous pregnancy. When we looked at how long it took to achieve pregnancy, we found that individuals in the SP-p group achieved pregnancy in 5.7 months, while subjects in the NSP-p group took 1.8 times longer than their peers in the SP-p group (p<0.001). However, once prescribed ART, the individuals in the NSP-p group achieved pregnancy within a similar time when compared with subjects in the SP-p group. In order to identify individuals that might benefit from ART early on, we performed a multivariable analysis and developed a decision tree (81.3% accuracy and 53.3% sensitivity).

CONCLUSIONS

The present results indicated that, after surgery, the majority of patients achieved spontaneous pregnancy. The decision tree proposed in this study allows the early identification of patients who might require ART, thus decreasing the time between surgery and pregnancy and improving overall outcomes.

Incidental gall bladder cancer in the laparoscopic treatment and magnetic resonance imaging era: A single institution experience

BACKGROUND

Incidental gall bladder cancer (IGBC) is often discovered unexpectedly in patients after cholecystectomy. Currently, magnetic resonance imaging (MRI) has been widely applied in the pre-operative diagnosis of gall bladder diseases as laparoscopic cholecystectomy developed into the preferred method.

AIMS AND OBJECTIVES

This study aimed to evaluate the pre-operative MRI application and laparoscopic management in the IGBCs.

MATERIALS AND METHODS

Between January 2011 and January 2020, a total of 7917 patients with gall bladder diseases treated by laparoscopy were enrolled in this study.

RESULTS

Amongst 49 patients diagnosed with IGBCs, the incidence of IGBCs in polypoid lesions, biliary pancreatitis, cholecystitis, cholecystocholedocholithiasis and gall bladder stones was 0.42%, 1.19%, 0.62%, 1.20% and 0.49%, respectively. MRI evaluation showed more remarkable pre-operative imaging as compared to ultrasonographic evaluation (40.8 vs. 26.5, P < 0.05). Furthermore, 14 patients were diagnosed with gall bladder cancer through intraoperative histological examination and 11 received laparoscopic extensive resection after cholecystectomy. MRI findings with diffuse thickening of the gall bladder detected IGBCs with 6.1% sensitivity, 96.02 specificity, 0.95% positive predictive values and 99.4% negative predictive values; diffuse thickening of the gall bladder with suspicion of malignancy detected IGBCs with 12.2% sensitivity, 99.1% specificity, 7.6% positive predictive values and 99.5% negative predictive values; focal thickening of the gall bladder detected IGBCs with 16% sensitivity, 99.8% specificity, 32% positive predictive values and 99.5% negative predictive values; moreover, suspicious lesion detected IGBCs with 6.1% sensitivity, 99.6% specificity, 8.8% positive predictive values and 99.4% negative predictive values.

CONCLUSIONS

Patients with biliary pancreatitis and cholecystocholedocholithiasis have a higher incidence of IGBC. MRI evaluation could provide more accurate information for the IGBCs, which should be recommended for patients accepting cholecystectomy. MRI findings exhibited an unsatisfactory sensitivity when detecting IGBCs, but they represented high specificity. Pre-operative MRI evaluation and intraoperative histological examination may help some IGBCs to achieve one-stage laparoscopic extensive resection.

Laparoscopic treatment of colonic endometriosis causing periodic abdominal pain and hematochezia: A case report

RATIONALE

Endometriosis, a benign disease, has a malignant biological behavior and is highly prone to recurrence. Although gastrointestinal involvement is the most common site for extra-genital endometriosis, deep infiltrative endometriosis, which affects the mucosal layer, is very rare.

PATIENT CONCERNS

A 44-year-old woman with a 6-month history of recurring abdominal pain and Hematochezia. The patient visited several hospitals over the past six months and was suspected to have been diagnosed with a digestive disease, for which medication was ineffective, leading to a great deal of anxiety.

DIAGNOSES

Colonic endometriosis.

INTERVENTIONS

After a thorough imaging evaluation and preoperative discussion, laparoscopic colonic endometriosis resection under indocyanine green indication was performed by gynecologists and gastroenterologists.

OUTCOMES

After laparoscopic treatment, the patient's symptoms improved significantly, with occasional pain felt and no blood in the stool.

LESSONS

This case provides a rare example of sigmoid endometriosis causing periodic abdominal pain and Hematochezia. We report a clinical case to investigate the feasibility of an indocyanine green fluorescent contrast technique to guide the scope of surgery in laparoscopic deep infiltrative endometriosis surgery. In intestinal endometriosis surgery, indocyanine green fluoroscopy may indicate the lesion's precise localization.

Leptomeningeal Carcinomatosis: A Rare Presentation of Perforated Gastric Cancer

Leptomeningeal carcinomatosis (LMC) or leptomeningeal metastasis is defined as metastasis to the pia mater, arachnoid, and subarachnoid space. Only very few patients with cancer have LMC. In the practice of general surgeons, this diagnosis is rarely, if ever, encountered. We present a rare case of a patient presenting to ED with worsening headaches over several months that developed acute-onset abdominal pain while being evaluated. Further workup showed free air, and the patient was taken emergently to the OR, where a perforated gastric ulcer was identified and biopsied. Pathology revealed gastric adenocarcinoma and subsequent MRI pointed to suspected LMC. Unfortunately, till today there is no effective treatment for advanced-stage gastric cancer, and aggressive intrathecal chemotherapy is only available to mitigate leptomeningeal involvement.

Descending Colon Perforation Due to Ingestion of Foreign Body

Foreign body ingestion is a common reason for emergency department (ED) visits, with rare complications necessitating immediate surgical intervention. This case report discusses diagnosis and treatment, emphasizing the importance of prompt intervention. A 45-year-old male with dentures presented with acute left abdominal pain. Diagnostic tests identified a foreign body in the descending colon, leading to laparoscopic surgery. Early laparoscopy offers a safe and reliable alternative to exploratory laparotomy. This case underscores the significance of swift diagnosis, preventing severe complications like peritonitis, obstruction, and hemorrhage. In conclusion, while foreign body ingestion is common, intestinal perforation remains extremely rare. Physicians should consider it in their differential diagnosis, with computed tomography (CT) and rapid surgical intervention as crucial components of proper management.

Laparoscopic Reduction and Repair of a Mesocolic Hernia Causing Small Bowel Obstruction: A Case Report and Review of Literature

Mesocolic hernias are a rare cause of small bowel obstruction that occurs when a loop of small bowel herniates through a defect in the mesocolon. We present a case of a 35-year-old male with a mesocolic hernia causing small bowel obstruction, who was successfully treated with laparoscopic reduction and repair. The patient had an uneventful recovery and was discharged on postoperative day 3. Mesocolic hernias should be considered in the differential diagnosis of small bowel obstruction, and prompt diagnosis and surgical intervention are essential to prevent complications such as bowel ischemia and perforation. Laparoscopic treatment can be a safe and effective option for the management of mesocolic hernias. This case report highlights the clinical presentation, radiological features, and surgical management of mesocolic hernias, with a focus on the role of laparoscopy in the treatment of this rare condition.

Clinical effects of laparoscopic surgery for the treatment of endometriosis and endometriosis-fertility: A retrospective study of 226 cases

Introduction

To determine the clinical effects of laparoscopic surgery (LS) in the treatment of endometriosis and endometriosis-fertility.

Methods

Two hundred twenty-six patients with endometriosis who underwent LS (LS group, n = 176) or laparotomy (LT group, n = 50) at the Third Hospital of Shijiazhuang City from June 2011 to June 2013 were included in this study, and their clinical outcomes for endometriosis and infertility were compared. All patients were followed up for 1 year after surgery to determine postoperative pregnancies in patients with endometriosis.

Results

The operative times between the LS and LT groups were not significantly different (P > 0.05); however, the length of stay in the hospital and blood loss in the LS group were significantly different from the LT group (P < 0.05). The incidence of postoperative symptoms were lower in the LS group than the LT group (P < 0.05). The postoperative pregnancy rates in the two groups were significantly different, including the infertility patients (P < 0.05).

Conclusions

Compared with LT, LS significantly reduced pain and improved the quality of life in women with endometriosis. These results can provide a reference for the clinical treatment of endometriosis.

The Spectrum of Treatment Modalities for Gastroesophageal Reflux Disease (GERD): A Narrative Review

Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disease that is encountered and treated by physicians all over the world. It is a chronic and non-progressive condition. Symptoms can range from mild heartburn to chronic, recurrent, and severe symptoms like constant acid regurgitation, laryngitis, bad breath, otitis media, and severe heartburn, which can be debilitating to the patient. Hence, the administration of appropriate therapy according to the patient's severity of symptoms is imperative, more so because over-the-counter drugs like antacids are very common to treat GERD. Often, in some instances, mere changes in lifestyle prove highly effective in reversing GERD symptomatology. Depending on the severity, response to treatment, and presence or absence of complications, treatment with medical or surgical modalities can be decided. It has now been found that although the gold standard in medical therapy for GERD has been proton pump inhibitors (PPIs), there has been increasing research about their side effects and recurrence after treatment. Hence, newer anti-GERD drugs have been under trial, which has been discussed in detail in the review. The use of surgical fundoplications has drastically decreased and is being widely replaced by incisionless laparoscopic fundoplications and newer endoluminal techniques such as the LINX device. This review aims to compile the vast spectrum of treatment modalities for GERD, ranging from more contemporary diagnostic methods, lifestyle modifications, medical therapy, and surgical and endoluminal techniques, with a particular focus on newer directions.

Cervical stump necrosis after laparoscopic supracervical hysterectomy: successful management by laparoscopic approach

Persistent bleeding from the remaining cervix after laparoscopic supracervical hysterectomy (LSH) is normally related to the presence of residual functioning endometrial tissue. However, postoperative significant vaginal hemorrhage caused by cervical necrosis following LSH is relatively rare. A 39-year-old nulligravida was admitted to the emergency department with hypovolemic shock after LSH performed in another hospital for treatment of uterine fibroids 18 days previously. Following hemodynamic stabilization and mechanical tamponade of the bleeding uterine cervix, laparoscopic simple trachelectomy was carried out and antibiotics were administered. The patient developed no surgical or clinical complications and was discharged 4 days after surgery. Histologic examination revealed extensive areas of tissue necrosis and no signs of malignancy. Stump necrosis and accompanying bleeding are rare but serious complications of LSH. Infection is an important component of this entity and should be treated. Endoscopic management of this condition appears to be feasible and safe.

Pregnancy outcomes in patients with tubal infertility following laparoscopic treatment: a multivariate predictive study

BACKGROUND

Tubal infertility represents a large portion of female infertility. This study analyzed the pregnancy outcomes of patients with tubal infertility after laparoscopic treatment. A multivariate predictive analysis was also conducted.

METHODS

The clinical data of 92 patients admitted in our hospital from March 2015 to March 2018 with tubal infertility were analyzed. According to the inclusion and exclusion criteria, 87 patients were finally included, and all patients were treated with laparoscopy. The clinical data of all study subjects were collected, including age, years of infertility, type of infertility, history of pelvic surgery, history of tubal pregnancy, history of artificial abortion, and lowest tubal function score. The patients were followed up for two years, and multiple logistic regression was used to analyze the factors affecting the pregnancy outcomes of patients with tubal infertility after laparoscopic treatment. The receiver operating characteristic (ROC) curve was used to analyze the predictive values.

RESULTS

Among the 87 patients, 63 cases (72.41%) had successful pregnancies at follow-up, and 24 cases (27.58%) were not pregnant. The time of follow up (half a year, 1 year, and 2 years) was not significantly different between the pregnant and the non-pregnant groups. There were no significant differences in the infertility types, pelvic surgery history, and induced abortion history between two groups (P>0.05), However, there were differences in the age, years of infertility, tubal pregnancy history, and lowest tubal function score (P<0.05). Multivariate analyses showed that the patient's age over 35 years, a lowest tubal function score indicating severe injury, and a history of tubal pregnancy were independent risk factors for the pregnancy outcome of patients with tubal infertility after laparoscopic treatment (P<0.05). The area under the ROC curve for age, lowest tubal function score, tubal pregnancy history, and the three combined curves were 0.792, 0.852, 0.816, and 0.949, respectively.

CONCLUSIONS

The age of the patient, the lowest tubal function score, and the tubal pregnancy history are independent risk factors for the pregnancy outcome of patients with tubal infertility after laparoscopic treatment. Furthermore, the combination of the three risk factors can be used as a predictor of the pregnancy outcome in patients with tubal infertility after laparoscopic treatment.

Evaluation of the Diagnostic Value of Contrast-Enhanced Voiding Urosonography with Regard to the Further Therapy Regime and Patient Outcome-A Single-Center Experience in an Interdisciplinary Uroradiological Setting

Background and Objectives: Vesicoureteral reflux (VUR) describes a common pediatric anomaly in pediatric urology with a prevalence of 1-2%. In diagnostics, in addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. In the present single-center study, subsequent therapeutic procedures and outcomes after ceVUS of 49 patients were investigated. The aim of the study is to investigate the efficacy of ceVUS with the intention of broader clinical implementation. Materials and Methods: Between 2016 and 2020, 49 patients were retrospectively included and received a ceVUS to evaluate VUR. With a distribution of 47:2 (95.9%), a clear female predominance was present. The age of the patients varied between 5 months and 60 years at the time of ceVUS. All examinations were all performed and subsequently interpreted by a single experienced radiologist (EFSUMB level 3). Results: Compared to intraoperative findings, ceVUS shows a sensitivity of 95.7% with a specificity of 100%. Allergic reactions to the contrast medium could not be observed. Conclusion: With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children.

Laparoscopic selective esophagogastric devascularization and splenectomy for patients with cirrhotic portal hypertension

Introduction

The role of laparoscopic selective esophagogastric devascularization and splenectomy (LSEGDS) in the treatment of esophagogastric variceal bleeding and hypersplenism in patients with cirrhotic portal hypertension has not been well studied.

Aim

To investigate the safety and efficacy of LSEGDS for esophagogastric variceal bleeding and hypersplenism in patients with cirrhotic portal hypertension.

Material and methods

From May 2011 to December 2014, 74 patients with portal hypertension resulting from liver cirrhosis underwent surgery for gastroesophageal variceal bleeding and hypersplenism. Forty-one of these patients underwent laparoscopic esophagogastric devascularization and splenectomy (LEGDS), and the others underwent LSEGDS. A retrospective comparative analysis of clinical data was conducted between the two groups, including clinical characteristics, laboratory data, operative morbidity and mortality, and outcomes of follow-up.

Results

The operation was completed successfully in all the patients, except that conversion was required in one patient in the LEGDS group. The operating time was similar in both groups (p = 0.579). The intraoperative blood loss was lower in the LSEGDS group (p = 0.011). Postoperative complications showed no significant difference between the two groups regarding mortality rate, pleural effusion, pancreatic injury, pulmonary infection, liver dysfunction, or postoperative abdominal bleeding. Postoperative platelet counts increased significantly more in the LEGDS group than in the LSEGDS group (p = 0.004). There were no significant differences in the long-term follow-up data, such as incidence of rebleeding, portal vein thrombosis, hepatic encephalopathy and survival (p > 0.05).

Conclusions

The LSEGDS is a safe and effective procedure for management of cirrhotic portal hypertension, especially in patients with visible paraesophageal veins.

Laparoscopic treatment of median arcuate ligament syndrome

Median arcuate ligament syndrome (MALS) refers to a clinical syndrome caused by compression of the median arcuate ligament due to the fibers of this ligament that connect the diaphragmatic crura on the two sides of the aortic foramina, forming the anterior edge of the aortic foramina. If MALS is suspected, invasive digital subtraction angiography and computed tomography angiography or magnetic resonance angiography (MRA) can be used to verify the location of the celiac trunk. A disrupted or increased blood flow in the proximal end of the celiac trunk can be detected with doppler ultrasound, indicating stenosis. Treatment needs to alleviate celiac trunk compression. A common procedure involves separation of the ligament fibers and other surrounding tissues around the beginning of the celiac trunk. This can be achieved by either laparotomy or laparoscopic surgery. Patient prognosis is good, with a cure rate of about 80%.

Recurrent Massive Uterine Bleeding from a Cesarean Scar Treated Successfully by Laparoscopic Surgery

A cesarean scar can cause abnormal uterine bleeding including prolonged menstruation or postmenstrual spotting. Our patient showed massive uterine bleeding from a cesarean scar and needed blood transfusion for hemorrhagic shock. A cesarean section had only been performed once for delivery stop 9 years ago. Recurrent hemorrhage could not be controlled by conservative treatment, and we performed laparoscopic scar resection and repair. The abnormal uterine bleeding was successfully stopped, and the menstrual cycle was normalized after surgical treatment. We should be aware that even an uneventful cesarean section may have a risk of massive hemorrhage postoperatively as in the present case.

Updates in Mirizzi syndrome

Mirizzi syndrome, known as extrinsic bile compression syndrome, is a rare complication of cholecystitis and chronic cholelithiasis, secondary to the obliteration of the infundibulum of the gallbladder or cystic duct caused by the impact of one or more calculations in these anatomical structures, which leads to compression of the adjacent bile duct, resulting in partial or complete obstruction of the common hepatic duct, triggering liver dysfunction. Our aim is to identify and describe the current epidemiology, diagnostic methods, and treatment of Mirizzi syndrome. A literature search was performed using different databases, including Medline, Cochrane, Embase, Medscape, PubMed, using keywords: Mirizzi syndrome, epidemiology, markers, pathophysiology, clinical presentation, diagnosis, and treatment. Selected original articles, review articles or case reports from 1997 to 2015 were collected, written in English or Spanish. The endoscopic retrograde cholangiopancreatography (ERCP) is the most accurate diagnostic method. The traditional treatment has been surgery and involves an incision at the bottom of the gallbladder and calculus removal. If fistulas are observed, it is performed a partial cholecystectomy; otherwise, a cholecystocholedochoduodenostomy is an alternative. Endoscopic treatment includes biliary drainage and stone extraction. Many surgeons claim that laparoscopic cholecystectomy is contraindicated in Mirizzi syndrome because of the presence of inflammatory tissue and adhesions in the Calot's triangle. If dissection is attempt, it can cause unnecessary injury to the bile duct. However, other surgeons consider the laparoscopic approach is feasible, although technically challenging. Currently, laparoscopic cholecystectomy for this condition is considered controversial and technically challenging; however, it has shown that with the right skills and equipment, it is a safe and feasible way to treat some cases of Mirizzi syndrome type I and II.

Laparoscopic treatment of Page kidney: a report of two cases and review of the literature

Page kidney is defined as the external compression of the kidney, typically by a subcapsular hematoma, that leads to hypertension due to hypoperfusion and ischemia. The treatment options include medical anti-hypertensive treatment, percutaneous drainage, surgical decortication and nephrectomy. Laparoscopic decortication of Page kidney is a newly defined minimally invasive management technique. We describe 2 cases of Page kidney that failed to improve with percutaneous drainage but were successfully treated with the laparoscopic approach.

Predictors for length of hospital stay after inguinal hernia surgery

AIM

identifying the variables that can help in quantifying/ predicting duration of hospital stay after inguinal hernia surgery.

METHOD

257 patients who were diagnosed with inguinal hernia underwent surgery between January 2013 and October 2014 and were prospectively registered and statistically analyzed by using linear regression with the aim of emphasizing, calculating and validating the predictors for duration of hospital stay.

RESULTS

out of 257 patients, 50,7% underwent laparoscopic surgery (TAPP and TEP) and 49,7% had an anterior approach by using the technique described by Lichtenstein in most of the cases. From the variables registered in the study (age, recurrence, emergency surgery, ASA [American Society of Anesthesiologists] risk classification, surgery duration, local and general complications) only the age and presence/absence of complications were statistically associated with the modification of the duration of hospital stay in this pathology.

CONCLUSIONS

the duration of hospital stay can be evaluated preoperatory by using a mathematical model, which takes into consideration factors that depend on the patient or the procedure, with results that can have a significant impact on planning the local resources.

Laparoscopic management of interstitial pregnancy and fertility outcomes after ipsilateral salpingectomy - three case reports

Background: Interstitial pregnancy after ipsilateral salpingectomy is a rare event with potentially serious consequences. Optimal management strategy remains uncertain and debated. In addition, fertility sparing is determinant of the treatment choice.

Cases: Here, we report three cases of interstitial pregnancy occurring after homolateral salpingectomy. We expose the therapeutic option held in all three situations, which associated laparoscopic procedure followed by intramuscular methotrexate injection with successful outcome for all patients. We also report the fertility outcome for the first patient, discussing the timing and mode of delivery. Cesarean section at term was performed for this patient.

Conclusion: In these three situations, we obtained a successful result using a minimally invasive surgical approach combined with systemic methotrexate injection. Cesarean section at term for subsequent intrauterine pregnancy seems to be the safest delivery strategy, although no clear data exist in literature.

[Not Available]

The anatomy facing a surgeon during cholecystectomy is challenging as it involves complex relationship between the gallbladder, hepatic artery and extra-hepatic billiary tree. We report a case of septate gall bladder which was successfully treated with laparoscopic cholecystectomy. In this paper, we also discuss the embryology and characteristics of this rare anomaly. Lack of awareness, non-specific symptoms, signs and inadequacy of imaging methods are possible reasons for the reported problem of overlooking of this entity. Complete identification and removal of gallbladder is mandatory, as a remnant may result in recurrence of symptoms or stones.

Controversies in the laparoscopic treatment of hepatic hydatid disease

BACKGROUND

Laparoscopic treatment of hydatid disease of the liver can be performed safely in selected patients.

METHODS

Six hundred and fifty patients were treated for hydatid disease of the liver between 1980 and 2003 at the Hepatopancreatobiliary Surgery Unit of Istanbul Medical Faculty, Istanbul University. Of these, 60 were treated laparoscopically between 1992 and 2000. A special aspirator-grinder apparatus was used for the evacuation of cyst contents. Ninety-two percent of the cysts were at stages I, II or III according to the ultrasonographic classification of Gharbi.

RESULTS

Conversion to open surgery was necessary in eight patients due to intra-abdominal adhesions or cysts in difficult locations. There was no disease- or procedure-related mortality. Most of the complications were related to cavity infections (13.5%) and external biliary fistulas (11.5%) resulting from communications between the cysts and the biliary tree. There were two recurrences in a follow-up period ranging between 3.5 and 11 years.

DISCUSSION

Laparoscopic treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. Our specially designed aspirator-grinder apparatus was safely used to evacuate the cyst contents without causing any spillage. Knowledge of the relationship of the cyst with the biliary tree is essential in choosing the appropriate patients for the laparoscopic technique. In our experience of 650 cases, the biliary communication rate was as high as 18%; half of these can be detected preoperatively. In the remaining, biliary communications are usually detected during or after surgery. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy are helpful to overcome this problem. As hydatid disease of the liver is a benign and potentially recurrent disease, we advocate the use of conservative techniques in both laparoscopic and open operations.

Laparoscopic treatment of hepatic hydatid cysts with a liposuction device

OBJECTIVE

We describe herein a surgical technique, whereby we use a liposuction device for the laparoscopic treatment of hepatic hydatid cysts (HHC).

METHODS

Ten patients with 12 hepatic hydatid cysts were treated with this technique. All patients received pre- and postoperative antiscolecidal medications. The laparoscopic technique consisted of partial aspiration of the cyst fluid and replacement of the aspirated fluid with 10% Betadine. The Betadine solution was left in situ for 10 minutes. Evacuation of the cyst contents was carried out with the liposuction device. The residual cavity was unroofed by partial excision of the ectocyst. A drain was left alongside the cyst. No intra- or postoperative complications were encountered.

RESULTS

All patients were mobilized freely, were allowed to eat a regular meal 6 hours after recovery from anesthesia, and were discharged on the third postoperative day. All patients resumed their normal household and work activities by the tenth postoperative day. The patients were regularly followed up every 2 months for 2 years. At follow-up in the surgical clinic, no evidence of recurrence was noted either clinically, serologically, or by imaging techniques.

CONCLUSION

We conclude that the laparoscopic treatment of HHC is feasible and advantageous. We believe that the use of a liposuction device facilitates rapid and efficient evacuation of the viscid organic contents of the cyst and helps in the obliteration of the residual cavity.