Role of Laparoscopy in Management of Liver Hydatid Disease: A Tertiary Care Institute Experience

Ravinder Pal Singh Babra, MBBSMS, Jaspal Singh, MBBS, MS, DNB, Atul Mishra, MBBS, MS, Ashish Ahuja, MBBS, MS, Amandeep Nar, MBBS, MS, Ashvind Bawa, MBBS, MS. Dayanand Medical College & Hospital Ludhiana Punjab India

INTRODUCTION: Laparoscopic methods with their low morbidity have nearly replaced open surgical methods including the treatment of hepatic hydatid disease. Numbers of cases have been reported for successful laparoscopic management of hepatic cyst including laparoscopic management of complex and parasitic cyst.

METHODS AND PROCEDURES: Twenty one consecutive patients with liver hydatid cyst were considered for laparoscopic treatment from April 2007 to April 2012. Preoperative work up included abdominal ultra sound and contrast enhanced computer tomography scan of abdomen. Immunological tests for confirmation of hydatid disease were also carried. Diagnosis of liver hydatid was based on imaging studies and clinical suspicion. All patients were treated preoperatively with albendazole. Patient undergoing surgery had laparoscopic cyst evacuation after its sterilization and deroofing and suction drainage of the cavity and omentoplasty where required.

RESULTS: Twenty one patients (M 14: F 7) with liver hydatid cysts underwent laparoscopic surgery. Average operative time was 125 minutes. Most of patients had only single cyst. The right lobe of liver was most commonly involved. Mean cyst size was 8.2 cm (range; 5.2 cm to 16.2 cm). Cyst was bilateral in four patients. In 86 % simple evacuation of the hydatid cyst using wide bore suction was done. In 12.5 % this was followed by left lobectomy. The remnant cavity was dealt with omentoplasty. Average follow up period is 2.8 years. There has been no recurrence rate.

CONCLUSION: With proper patient selection laparoscopic management of hydatid cyst of the liver is a feasible option. We found laparoscopic treatment to be having optimum efficacy for preventing spillage, evacuating hydatid cyst contents, performing trans cystic fenestration and for dealing with cyst biliary communication.