Laparoscopic Treatment of Liver Hydatid Disease in Cases of Cyst Rupture

Serik Tokpanov, Sagidulla Dosmagambetov, Vladimir Kotlobovskiy. 1. Hospital of the Presidents Administration of Republic of Kazakhstan, Astana, Kazakhstan 2. Department of Laparoscopic Surgery, Regional Pediatric Hospital, Aktobe, Kazakhstan.

Aim. Evaluation of efficiency of laparoscopic treatment of liver hydatid disease in cases of cyst rupture.

Materials. Since 1993 till September 2013 436 patients ranging from 4 to 68 years of age with hydatid disease underwent surgery. In 264 (60,5%) cases hydatid located in liver, 93 (21,3%) cases – in lung, 41 (9,4%) cases – in kidney, 9 (2%) cases – in omentum, 6 (1,4%) cases – in uterine tubes, 5 (1,1%) cases – in spleen, 5 (1,1%) cases – in brain, 5 (1,1%) cases – in retroperitoneal space, 3 (0,7%) cases in mussels, 3 (0,7%) cases in pancreas. There were 15 (5,7%) urgent cases of acute peritonitis because of liver cysts rupture. In 9 (62,5%) cases cyst rupture was associated with trauma. In 6 (37,5%) cases it happened spontaneously. We used abdominal ultrasonography, CT, MRT scan as a diagnostic procedures before surgery. In 10 (66%) patients we performed laparoscopic approach for treatment of th?se complicated, in 5 (33,3%) – open surgery. Fore trocars approach was performed (10, 6, 6, 22 mm). Free hydatid fluid was identified and aspirated from abdomen cavity. In 6 (60%) cases ruptured echinococcus cyst were localized in a right lobe, in 4 (40%) – in a left. We used 22 mm trocar for vacuum extraction of endocyst. Abdomen cavity was irrigated by saline solution. We performed betadine solution for the processing of fibrous capsule. One tube used for draining of every residual cavity, one, or two – for draining of the abdominal cavity. All patients accepted 10 mg/kg of albendazolum during 6 weeks postoperatively. Operation time, conversion rate, complications rate, length of hospital stay were analyzed.

Results. It was no mortality. Duration of operation time was 67.1+-14.2 min. It was 1 (10%) case of billiary peritonitis, associated with billiary fistula. Laparoscopic suturing of billiary fistula was performed on a third day after primary procedure. Duration of the hospital stay was 10.6+-1.3 days. It was one (10%) case of recurrence with dissemination of the process in an abdomen cavity.

Conclusions. Laparoscopic approach could be successfully performed for treatment of liver hydatid disease in cases of cyst rupture. It demonstrates good post-operative results, low rate of complications and recurrence, short duration of operation and hospital stay.

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