C Palanivelu, MS, MCH, FACS, P Senthilnathan, MS, FACS, R Parthasarathi, MS, P Praveen Raj, MS, V P Nallankilli, MS, I Swathi, MS, S Sandeep, MS. GEM Hospital & Research Centre, Coimbatore, INDIA.
Surgical management of hydatid disease of the live can be challenging. Both conservative and radical surgeries are being followed worldwide with merits and demerits in each approach.
Aim is to review the presentation, management and longterm outcomes of patients who underwent laparoscopic surgery for the hydatid disease using Palanivelu Hydaid Trocar system (PHS) in a single institution over a 17 years period
A retrospective review of all patients who were managed from 1997 to May 2013 for hydatid disease formed the study group. PHS system is a 12 mm continuous suction irrigation apparatus, which minimizes spillage of contents and also facilitates intracystic visualization. Clinical presentation, surgical modalities, perioperative complications and outcomes were analyzed.
116 patients underwent surgery for hydatid disease over the study period of which 11 patients were excluded due to radical procedure done in these patients. Mean age is 32 years with male/female ratio of 76/29. The most common presentation was abdominal pain (58%), 16(15%) had multiple cysts of which 9(8%) were in both lobes. 77(73.3%) cysts were uncomplicated. Out of 28 complicated cases 19(17%) had cyst-biliary communication, 2 were ruptured cysts (intraperitoneally, mediastinum and stomach) and 7 recurrent cysts. All of them underwent successful laparoscopic management using PHS trocar decompression and partial cystectomy. Postoperative infection was noted in 2, bile leak in 14 (all except one were managed conservatively). Mean hospital stay was 3.2 days and follow up was 5.2 years with 15 patients lost for follow up. The recurrence was seen in 2 patients
PHS is a simple, safe and effective tool to treat hepatic hydatid cysts with excellent long term results which are comparable to radical surgery. Its closed suction and irrigation principle avoids intra peritoneal spillage thereby resulting in better outcomes.