Aditya Kumar, Hemanga K Bhattacharjee, Manjunath Bale, Suhani Suhani, Rajinder Parshad. All India Institute of Medical Sciences
Introduction: Hydatid disease is a rare zoonotic disease, still prevalent in some parts of the world including India. Open surgery is still common worldwide, but minimal access techniques are gaining momentum. Several techniques have been described in literature and we have been using laparoscopic deroofing of the cyst using a 150mm, 12mm Xcel® trocar. Specific advantages seen are minimal spillage on puncture owing to serrations on the body of the trocar which snuggly fits with the cyst wall. A transparent body eases evaluation of contents. It is also used to irrigate the cyst with scolicidal agents and suction contents with a 10mm catheter. A triple layer of 10% povidone iodine soaked gauze to isolate the cyst cavity prior to puncture is done to reduce intraperitoneal contamination. Additionally, another povidone iodine soaked gauze is placed at the port site post removal to reduce port site recurrence. We are using this approach for almost 10 years with acceptable results. Here, we demonstrate the procedure in this video presentation.
Materials & methods: A 38-year-old male preseted with dragging pain in the right upper abdomen since eight months with no fever, jaundice or comorbidities. A non-tender swelling was palpated 4 cms below the right subcostal margin. LFT were normal and a hydatid serology was positive. CECT Abdomen revealed a 12x6x10 cm cystic swelling in segments 5 and 6 of liver with daughter cysts. He received tablet albendazole 400 mg daily for three weeks. Patient was taken for surgery and adhesiolysis was performed to isolate the cyst. Triple layer of 10% povidone iodine soaked gauze pieces were placed adjacent to the cyst. A 12 mm, 150mm Xcel® trocar was used to puncture the cyst. Contents were removed using a 10mm suction catheter. Deroofing of the cyst wall was done and the cavity was instilled with 3% NaCl solution for 20 minutes. A cystobiliary communication was sutured using a 3-0 polypropylene suture. The excised tissue and gauze were removed in an endocatch bag. Omentum was used to obliterate the cyst cavity and a drain was placed. Procedure was uneventful and the drain removed on POD2. Patient was discharged a day later on tablet Albedazole 400mg daily for 3 weeks.
Conclusion: Laparoscopic deroofing of hydatid cysts of the liver using 150mm, 12mm Xcel® laparoscopic trocar may be used as a minimal access technique with acceptable results.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95101
Program Number: V043
Presentation Session: Exhibit Hall Theater Video Session I
Presentation Type: EHVideo
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