Laparoscopic Treatment of Hepatic Hydatid Disease

Lucian Panait, MD, Ionut E Iordache, MD, Octavian D Unc, MD

Drexel University College of Medicine, Philadelphia, PA; Ovidius University of Constanta, Romania

INTRODUCTION: The objective of this study is to present our experience with the laparoscopic treatment of hepatic hydatid disease and to discuss the benefits and limitations offered by this approach.

METHODS: A retrospective chart review was conducted in our institution to identify patients operated for hepatic hydatid cysts between 2004 and 2012. Of the total of 136 procedures performed for this condition, 30 were completed laparoscopically. Exclusion criteria for the laparoscopic approach were represented by preoperative imaging studies consistent with cyst size larger than 15 cm, the presence of calcified walls, completely intraparenchymal cyst, more than 3 hepatic cysts, or surgeon inexperience with the laparoscopic approach. Patients with preoperative jaundice underwent ERCP. If cyst-biliary fistula was diagnosed, these patients were also excluded from the laparoscopic approach.

RESULTS: All laparoscopic procedures were performed through 3 or 4 abdominal trocars, depending on cyst location. Conversion to open surgery was made in 4 patients (3 for inability to identify the cyst or difficult cyst locations and 1 for hemorrhage difficult to control laparoscopically). Biliary fistulas were present in 5 patients. These underwent figure-of-eight closure of the fistulous orifice, followed by trans-cystic biliary drainage or postoperative ERCP. Length of hospital stay averaged 4 days (range 2-8 days). There was no disease or procedure related mortality. Mean follow-up was 12 months. No recurrences were identified.

CONCLUSIONS: Laparoscopic treatment of the hepatic hydatid cyst is safe and effective in selected patients, and is associated with low morbidity and early recovery. Further studies should be encouraged in this field to determine a universally accepted standard technique.

Session: Poster Presentation

Program Number: P354

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