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Frenette C, Mendiratta-Lala M, Salgia R, Wong RJ, Sauer BG, Pillai A. ACG Clinical Guideline: Focal Liver Lesions. Am J Gastroenterol 2024; 119:1235-1271. [PMID: 38958301 DOI: 10.14309/ajg.0000000000002857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/25/2024] [Indexed: 07/04/2024]
Abstract
Focal liver lesions (FLLs) have become an increasingly common finding on abdominal imaging, especially asymptomatic and incidental liver lesions. Gastroenterologists and hepatologists often see these patients in consultation and make recommendations for management of multiple types of liver lesions, including hepatocellular adenoma, focal nodular hyperplasia, hemangioma, and hepatic cystic lesions including polycystic liver disease. Malignancy is important to consider in the differential diagnosis of FLLs, and healthcare providers must be familiar with the diagnosis and management of FLLs. This American College of Gastroenterology practice guideline uses the best evidence available to make diagnosis and management recommendations for the most common FLLs.
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Affiliation(s)
| | | | - Reena Salgia
- Department of Gastroenterology/Hepatology, Henry Ford Health, Detroit, Michigan, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, California, USA
| | - Bryan G Sauer
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago Medical Center, University of Chicago, Chicago, Illinois, USA
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Kahraman G, Haberal KM, Dilek ON. Imaging features and management of focal liver lesions. World J Radiol 2024; 16:139-167. [PMID: 38983841 PMCID: PMC11229941 DOI: 10.4329/wjr.v16.i6.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/28/2024] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
Notably, the number of incidentally detected focal liver lesions (FLLs) has increased dramatically in recent years due to the increased use of radiological imaging. The diagnosis of FLLs can be made through a well-documented medical history, physical examination, laboratory tests, and appropriate imaging methods. Although benign FLLs are more common than malignant ones in adults, even in patients with primary malignancy, accurate diagnosis of incidental FLLs is of utmost clinical significance. In clinical practice, FLLs are frequently evaluated non-invasively using ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Although US is a cost-effective and widely used imaging method, its diagnostic specificity and sensitivity for FLL characterization are limited. FLLs are primarily characterized by obtaining enhancement patterns through dynamic contrast-enhanced CT and MRI. MRI is a problem-solving method with high specificity and sensitivity, commonly used for the evaluation of FLLs that cannot be characterized by US or CT. Recent technical advancements in MRI, along with the use of hepatobiliary-specific MRI contrast agents, have significantly improved the success of FLL characterization and reduced unnecessary biopsies. The American College of Radiology (ACR) appropriateness criteria are evidence-based recommendations intended to assist clinicians in selecting the optimal imaging or treatment option for their patients. ACR Appropriateness Criteria Liver Lesion-Initial Characterization guideline provides recommendations for the imaging methods that should be used for the characterization of incidentally detected FLLs in various clinical scenarios. The American College of Gastroenterology (ACG) Clinical Guideline offers evidence-based recommendations for both the diagnosis and management of FLL. American Association for the Study of Liver Diseases (AASLD) Practice Guidance provides an approach to the diagnosis and management of patients with hepatocellular carcinoma. In this article, FLLs are reviewed with a comprehensive analysis of ACR Appropriateness Criteria, ACG Clinical Guideline, AASLD Practice Guidance, and current medical literature from peer-reviewed journals. The article includes a discussion of imaging methods used for the assessment of FLL, current recommended imaging techniques, innovations in liver imaging, contrast agents, imaging features of common nonmetastatic benign and malignant FLL, as well as current management recommendations.
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Affiliation(s)
- Gökhan Kahraman
- Department of Radiology, Suluova State Hospital, Amasya 05500, Türkiye
| | - Kemal Murat Haberal
- Department of Radiology, Başkent University Faculty of Medicine, Ankara 06490, Türkiye
| | - Osman Nuri Dilek
- Department of Surgery, İzmir Katip Celebi University, School of Medicine, İzmir 35150, Türkiye
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Mihetiu A, Bratu DG, Tanasescu C, Vintilă BI, Sandu A, Sandu M, Serban D, Sabau D, Hasegan A. Laparoscopic Management of Multiple Liver, Omental, Mesenteric, Peritoneal, and Round Ligament Hydatid Cysts-A Rare Report of a Case and a Systematic Literature Review. J Pers Med 2024; 14:205. [PMID: 38392638 PMCID: PMC10890065 DOI: 10.3390/jpm14020205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024] Open
Abstract
Hydatid cyst disease is a parasitic ailment with an endemic nature, predominantly affecting geographical areas with a tradition in animal husbandry. The most common localization of hydatid disease is in the liver (60%), followed by the lungs, with other organ localizations comprising less than 10%. The surgical approach to this condition can be carried out through open surgery or laparoscopy. The coexistence of hepatic and intraperitoneal hydatidosis often leads to the preference for open surgery. We performed a literature review aiming to retrieve data regarding demographic characteristics, clinical features, preoperative management, and surgical approach concerning these unusual localizations of hydatid disease. It was observed that the mesenteric localization frequently presented with acute abdominal pain (p = 0.038) and that the open approach was preferred in 85.71% of cases. Furthermore, an interdependence was identified between the localization of the cysts and the type of surgical approach (p = 0.001), with mesenteric localizations being approached through laparotomy and excision (p = 0.037), while omental localizations, due to the easier approach, benefited from laparoscopy with excision in 14.29% of cases. Overall, the laparoscopic approach was less frequently used, but its utilization resulted in a lower number of complications and faster recovery. Additionally, we present a rare case of hepatic and intra-abdominal hydatidosis, resolved exclusively through a laparoscopic approach, including a review of the literature for these uncommon localizations of hydatid disease. A 45-year-old patient diagnosed with multiple hydatid cysts, both hepatic and intraperitoneal, underwent surgical intervention with exploratory laparoscopy. Laparoscopic excision of peritoneal, epiploic, mesenteric cysts, and round ligament, along with laparoscopic inactivation, evacuation, and pericystectomy of hepatic hydatid cysts, was performed. The patient's recovery was uneventful, and she was reevaluated at 3 and 9 months without signs of recurrence. The association of hepatic hydatid cysts with multiple intra-abdominal localizations is not commonly encountered. The treatment of choice is surgical and is predominantly conducted through open surgery. The presented case is unique due to the exclusive laparoscopic approach in the management of mixed hepatic and intra-abdominal hydatidosis.
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Affiliation(s)
- Alin Mihetiu
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Dan Georgian Bratu
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Ciprian Tanasescu
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Bogdan Ioan Vintilă
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Alexandra Sandu
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Mariana Sandu
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
| | - Dan Sabau
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Adrian Hasegan
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
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Li YP, Zhang J, Li ZD, Ma C, Tian GL, Meng Y, Chen X, Ma ZG. Diagnosis and treatment experience of atypical hepatic cystic echinococcosis type 1 at a tertiary center in China. World J Gastroenterol 2024; 30:462-470. [PMID: 38414590 PMCID: PMC10895592 DOI: 10.3748/wjg.v30.i5.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/19/2023] [Accepted: 01/11/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Some hydatid cysts of cystic echinococcosis type 1 (CE1) lack well-defined cyst walls or distinctive endocysts, making them difficult to differentiate from simple hepatic cysts. AIM To investigate the diagnostic methods for atypical hepatic CE1 and the clinical efficacy of laparoscopic surgeries. METHODS The clinical data of 93 patients who had a history of visiting endemic areas of CE and were diagnosed with cystic liver lesions for the first time at the People's Hospital of Xinjiang Uygur Autonomous Region (China) from January 2018 to September 2023 were retrospectively analyzed. Clinical diagnoses were made based on findings from serum immunoglobulin tests for echinococcosis, routine abdominal ultrasound, high-frequency ultrasound, abdominal computed tomography (CT) scan, and laparoscopy. Subsequent to the treatments, these patients underwent reexaminations at the outpatient clinic until October 2023. The evaluations included the diagnostic precision of diverse examinations, the efficacy of surgical approaches, and the incidence of CE recurrence. RESULTS All 93 patients were diagnosed with simple hepatic cysts by conventional abdominal ultrasound and abdominal CT scan. Among them, 16 patients were preoperatively diagnosed with atypical CE1, and 77 were diagnosed with simple hepatic cysts by high-frequency ultrasound. All the 16 patients preoperatively diagnosed with atypical CE1 underwent laparoscopy, of whom 14 patients were intraoperatively confirmed to have CE1, which was consistent with the postoperative pathological diagnosis, one patient was diagnosed with a mesothelial cyst of the liver, and the other was diagnosed with a hepatic cyst combined with local infection. Among the 77 patients who were preoperatively diagnosed with simple hepatic cysts, 4 received aspiration sclerotherapy of hepatic cysts, and 19 received laparoscopic fenestration. These patients were intraoperatively diagnosed with simple hepatic cysts. During the follow-up period, none of the 14 patients with CE1 experienced recurrence or implantation of hydatid scolices. One of the 77 patients was finally confirmed to have CE complicated with implantation to the right intercostal space. CONCLUSION Abdominal high-frequency ultrasound can detect CE1 hydatid cysts. The laparoscopic technique serves as a more effective diagnostic and therapeutic tool for CE.
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Affiliation(s)
- Yu-Peng Li
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
| | - Jie Zhang
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
| | - Zhi-De Li
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
| | - Chao Ma
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
| | - Guang-Lei Tian
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
| | - Yuan Meng
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
| | - Xiong Chen
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
| | - Zhi-Gang Ma
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
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Yosra K, Ghada H, Bochra A, Fatma T, Said J, Riadh J. Predictive Factors of Liver Hydatid Cyst Recurrence in Children. J Pediatr Surg 2023; 58:2362-2367. [PMID: 37500372 DOI: 10.1016/j.jpedsurg.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Liver hydatid cyst affects approximately 95% of the world's echinococcosis cases. Despite advances in treatment, the recurrence rate remains high and is influenced by several factors that are yet to be determined. The objective of this study was to identify the predictive factors of liver hydatid cyst recurrence following surgery in children and to establish a treatment regimen aimed at preventing this postoperative morbidity. METHODS A bi-centric retrospective descriptive and analytic study was conducted involving 122 children who underwent surgery for liver hydatid cysts between January 1st, 2009, and December 31st, 2017. All factors that could potentially contribute to recurrence were thoroughly investigated. The data was processed using SPSS.v21, and a significant level of p-value 0.05 was applied. RESULTS Out of the 122 children, 20 patients experienced cyst recurrence (16.39%). Among them, there were nine girls and eleven boys. The median time of recurrence was 16.5 months. Abdominal ultrasonography demonstrated efficacy in detecting recurrence. Several factors were identified as predictors of postoperative recurrence, including intimate contact of the hydatid cyst with the large vessels (p = 0.031), intraperitoneal effusion (p = 0.042), bile duct dilation (p = 0.032), and postoperative spontaneous discontinuation of medical treatment (p = 0.010). Among these factors, two independent risk factors for recurrence were identified: intimate contact of the hydatid cyst with the large vessels (p = 0.011) and the presence of an intraperitoneal effusion (p = 0.018). CONCLUSION Our study has identified several predictors of postoperative recurrence, including two previously undocumented risk factors in the literature. Awareness of these risk factors can assist surgeons in implementing preventive measures to avoid the recurrence of hydatid cysts. LEVEL OF EVIDENCE Prognosis study Level II.
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Affiliation(s)
- Kerkeni Yosra
- Department of Pediatric Surgery "A", Children's Hospital, Tunis El Manar University, Tunis, Tunisia.
| | - Habachi Ghada
- Department of Pediatric Surgery "A", Children's Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Aziza Bochra
- Department of Pediatric Surgery "A", Children's Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Thamri Fatma
- Department of Pediatric Surgery "A", Children's Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Jlidi Said
- Department of Pediatric Surgery "B", Children's Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Jouini Riadh
- Department of Pediatric Surgery "A", Children's Hospital, Tunis El Manar University, Tunis, Tunisia
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Comparison of ethanol and hypertonic saline as a single ıntracystic agent in the percutaneous treatment of liver hydatid cysts. Abdom Radiol (NY) 2023; 48:1148-1153. [PMID: 36627404 DOI: 10.1007/s00261-022-03795-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE In this study, the effects of hypertonic saline and ethanol as a single intracystic agents in the percutaneous treatment of liver hydatid cysts were compared. METHODS The 50 patients were separated into two groups as those administered 30% hypertonic saline alone as the intracystic agent in percutaneous treatment (33 patients, 52 cysts), and those administered 96% ethanol alone (17 patients, 26 cysts). Both groups were compared in terms of percentage of cyst volume reduction, complications, and treatment success. RESULTS The follow-up period was median 17.0 months (11.0-20.0) in the ethanol group and 17.0 (14.0-22.0) in the hypertonic saline group (p = 0.269). Complications were observed in 5 (19.2%) cysts applied with ethanol as the intracystic agent and in 7 (13.5%) of the cysts where hypertonic saline was used (p = 0.521). Clinical success was evaluated as 100% in both groups. The percentage of cyst volume reduction according to the initial volume was determined as mean 75.6 ± 20.43 (28.19-98.13) in the ethanol group cysts and as 68.2 ± 16.45 (26.39-97.48) in the hypertonic saline group (p = 0.427). CONCLUSION The results of this study demonstrated similar efficacy of hypertonic saline and ethanol in the percutaneous treatment of CE1 and CE3A liver hydatid cysts. These results suggest that the use of hypertonic saline as a single intracystic agent in the percutaneous treatment of CE1 and CE3A liver hydatid cysts provides sufficient efficacy of treatment and cyst volume reduction. Nevertheless, there is a need for further prospective, randomized studies to support these findings.
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Özdemir M, Türk G, Bilgili M. Percutaneous treatment of giant hydatid cysts: a single-center experience of 58 cysts. Abdom Radiol (NY) 2023; 48:1409-1414. [PMID: 36774554 DOI: 10.1007/s00261-023-03841-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/13/2023]
Abstract
PURPOSE The aim of this study is to evaluate the efficacy of percutaneous treatment in hydatid cysts (HCs) with at least one diameter larger than 10 cm. MATERIALS AND METHODS 58 CE1 or CE3a HCs with at least one diameter larger than 10 cm which were treated with catheterization between September 2016 and December 2021 were retrospectively analyzed. RESULTS Mean age was 40 ± 17.7 (18-80). Majority of HCs were in the liver (89.6%). Median follow-up was 28 months. Technical success rate was 100%; however, a second procedure was needed in 13 cysts due to recollection (n = 4), infection (n = 6), and recurrence (n = 3). CONCLUSIONS Giant HCs can be effectively treated with catheterization with low complication rates.
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Affiliation(s)
- Mustafa Özdemir
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey.
| | - Gamze Türk
- Department of Radiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Mustafa Bilgili
- Department of Radiology, Kayseri Education and Research Hospital, Kayseri, Turkey
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Öztürk G, Uzun MA, Özkan ÖF, Kayaalp C, Tatlı F, Eren S, Aksungur N, Çoker A, Bostancı EB, Öter V, Kaya E, Taşar P. Turkish HPB Surgery Association consensus report on hepatic cystic Echinococcosis (HCE). Turk J Surg 2022; 38:101-120. [PMID: 36483170 PMCID: PMC9714645 DOI: 10.47717/turkjsurg.2022.5757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cystic Echinococcosis (CE) is one of the important problems of the Eurasian region. We aimed to prepare a consensus report in order to update the treatment approaches of this disease. This study was conducted by Turkish HPB Surgery Association. MATERIAL AND METHODS This study was conducted with the modified Delphi model. For this purpose, we conducted a three-stage consensus-building approach. RESULTS Six topics, including diagnosis, medical treatment, percutaneous treatment, surgical treatment, management of complications and posttreatment follow-up and recurrences in HCE were discussed. CONCLUSION The expert panel made recommendations for every topic.
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Affiliation(s)
- Gürkan Öztürk
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Mehmet Ali Uzun
- Clinic of General Surgery, Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Türkiye
| | - Ömer Faruk Özkan
- Clinic of General Surgery, Ümraniye Education and Research Hospital, İstanbul, Türkiye
| | - Cüneyt Kayaalp
- Department of General Surgery, Yeditepe University Faculty of Medicine, İstanbul, Türkiye
| | - Faik Tatlı
- Department of General Surgery, Harran University Faculty of Medicine, Şanlıurfa, Türkiye
| | - Suat Eren
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Nurhak Aksungur
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Ahmet Çoker
- Clinic of General Surgery, Medicana International İzmir Hospital, İzmir, Türkiye
| | | | - Volkan Öter
- Clinic of Gastroenterological Surgery, Ankara State Hospital, Ankara, Türkiye
| | - Ekrem Kaya
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Pınar Taşar
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
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Al Harbawi LQ, Jawad NK, AL-Dhahiry KJ, Abass KS. A retrospective analysis of surgical techniques and outcomes of hydatid disease in Wasit, Iraq. J Med Life 2022; 15:374-378. [PMID: 35450008 PMCID: PMC9015176 DOI: 10.25122/jml-2021-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
Echinococcosis is a parasitic infestation with high prevalence in Iraq. Surgical treatment remains the standard gold method for treating this disease. The selection of surgical approach depends on the general condition of the patient and characters of the cyst, e.g., size, location, number of cysts, intraoperative findings, and complications such as adhesion, bile leakage, and bleeding. Our study aimed (1) to summarize the most common surgical approaches for treating liver hydatid cyst (HC) in our locality, and (2) to highlight common intraoperative and postoperative complications and the duration of hospital stay. We analyzed the clinical data of 42 patients operated for liver HC. We found that the highest incidence rate of HC was anatomically in the right hepatic lobe with or without synchronous cysts in other organs. The most frequent type of surgery was partial pericystectomy with external tube drainage (ETD) or simple endocystectomy with omentoplasty and ETD. The most important intraoperative finding was cystic-biliary communication. The majority of patients had uneventful postoperative recovery. There is no standardized surgical procedure for hepatic HC. The surgical technique should be modified according to the cyst size, anatomic location of cyst/cysts, number of cysts, cystobiliary communications, cystic infection, and the presence of extrahepatic hydatid cyst or cysts. The surgeon's experience plays a vital role in selecting the surgical technique for hepatic hydatid cystectomy.
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Affiliation(s)
- Layth Qassid Al Harbawi
- Department of Anesthesiology, College of Medical Technology, AL-Kitab University, Kirkuk, Iraq,Department of Surgery, College of Medicine, University of Nineveh, Nineveh, Iraq,Corresponding Author: Layth Qassid Al Harbawi, Department of Surgery, College of Medicine, University of Nineveh, Nineveh, Iraq. E-mail:
| | - Naseer Kadhim Jawad
- AL-Karama Teaching Hospital, College of Medicine, University of Wasit, Wasit, Iraq
| | | | - Kasim Sakran Abass
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Kirkuk, Kirkuk, Iraq
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Baimakhanov Z, Kaniyev S, Serikuly E, Doskhanov M, Askeyev B, Baiguissova D, Skakbayev A, Sadykov C, Barlybay R, Seisembayev M, Baimakhanov B. Radical versus conservative surgical management for liver hydatid cysts: A single-center prospective cohort study. JGH Open 2021; 5:1179-1182. [PMID: 34622005 PMCID: PMC8485413 DOI: 10.1002/jgh3.12649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM We prospectively compared the clinical outcomes of radical and conservative surgical procedures for primary liver hydatid cysts, additionally radical surgical procedures with and without the two-month administration of albendazole after the operation were compared. METHODS Overall, 90 patients undergoing open surgical treatment for liver hydatid cysts were divided into three surgical groups: first group, patients who underwent radical surgery (pericystectomy) followed by albendazole treatment for 2 months following the operation group; second group, patients who underwent radical surgery(pericystectomy) without receiving albendazole after surgery group; third group, patients, who underwent conservative surgery (partial cystectomy) with albendazole treatment after surgery. The clinical outcomes and rate of recurrence were analyzed in follow-up period. RESULTS The mean surgery duration in the Radical groups was significantly longer in comparison to the Conservative surgery + Albendazole group. (212.0 and 202.5 min vs. 173.2 min; p < 0.05). Blood loss in the Radical groups was significantly higher in comparison to the Conservative surgery + Albendazole group (218.3 and 174.6 ml vs. 67.2 ml; p < 0.05). However, postoperative complication rate in the Radical group was significantly lower in comparison to Conservative surgery + Albendazole group (13.3% [n = 4] and 6.7% [n = 2] vs. 36% [n = 11]; p < 0.05). The postoperative hospital stay in both Radical groups was significantly lower in comparison to the Conservative surgery + Albendazole group (7.9 and 7.4 days vs. 11.3 days; p < 0.05). CONCLUSION In comparison to conservative surgery, radical surgery is a preferable treatment modality for patients with active liver hydatid cysts. Postoperative albendazole treatment is preferable, regardless of the type of surgical procedure.
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Affiliation(s)
- Zhassulan Baimakhanov
- Department of HPB Surgery and Liver Transplantation Syzganov's National Scientific Center of Surgery Almaty Kazakhstan
| | - Shokan Kaniyev
- Department of HPB Surgery and Liver Transplantation Syzganov's National Scientific Center of Surgery Almaty Kazakhstan
| | - Erbol Serikuly
- Department of HPB Surgery and Liver Transplantation Syzganov's National Scientific Center of Surgery Almaty Kazakhstan
| | - Maxat Doskhanov
- Department of HPB Surgery and Liver Transplantation Syzganov's National Scientific Center of Surgery Almaty Kazakhstan
| | - Baglan Askeyev
- Department of HPB Surgery and Liver Transplantation Syzganov's National Scientific Center of Surgery Almaty Kazakhstan
| | - Dinara Baiguissova
- Department of Radiology Syzganov's National Scientific Center of Surgery Almaty Kazakhstan
| | - Aidar Skakbayev
- Department of HPB Surgery and Liver Transplantation Syzganov's National Scientific Center of Surgery Almaty Kazakhstan
| | - Chingiz Sadykov
- Department of Radiology Syzganov's National Scientific Center of Surgery Almaty Kazakhstan
| | - Raikhan Barlybay
- Department of Radiology Syzganov's National Scientific Center of Surgery Almaty Kazakhstan
| | - Manas Seisembayev
- Department of HPB Surgery and Liver Transplantation Syzganov's National Scientific Center of Surgery Almaty Kazakhstan
| | - Bolatbek Baimakhanov
- Department of HPB Surgery and Liver Transplantation Syzganov's National Scientific Center of Surgery Almaty Kazakhstan
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Khuroo MS. Percutaneous Drainage in Hepatic Hydatidosis-The PAIR Technique: Concept, Technique, and Results. J Clin Exp Hepatol 2021; 11:592-602. [PMID: 34511821 PMCID: PMC8414317 DOI: 10.1016/j.jceh.2021.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022] Open
Abstract
Over decades, surgery has been the only accepted mode of treatment for liver hydatid cysts. It had been a surgical dogma for a long that hydatid disease is an absolute contraindication for needle puncture/aspiration as it can cause anaphylaxis, death, and dissemination. We envisaged prospectively perform percutaneous drainage as a primary form of treatment for hepatic hydatidosis. Through extensive and very careful experimentation, we proved that aspiration of hydatid cysts can be performed safely and is the ideal way to manage a subset of patients with hydatid cysts in the liver. The patient and cyst characteristics good and not good for percutaneous drainage were carefully selected. The procedure of percutaneous drainage of hepatic hydatid cysts involves four sequential steps as defined in the alphabets of the title PAIR, denoting puncture (P), Aspiration (A), Instillation (I), and Reaspiration (R). During and postprocedure, we enforced strict monitoring given the anticipated anaphylaxis. The first PAIR procedure was performed in June 1988. The results of percutaneous drainage of 21 cysts in 12 patients were reported in 1991. Next, a prospective study was done to show that concomitant Albendazole therapy is recommended as an adjuvant to percutaneous drainage for hepatic hydatidosis. In a seminal prospective study comparing percutaneous drainage and surgery, we showed that percutaneous drainage is as good as surgery in the management of uncomplicated hydatid cysts with fewer complications and shorter hospital stays. Lastly, long-term follow-up results of percutaneous drainage on a large cohort of patients with hepatic hydatid cysts were reported, with excellent results and no evidence of local, peritoneal or systemic dissemination. Based on these data percutaneous drainage, the so-called PAIR technique has established itself as a novel therapeutic advance in hepatic hydatid disease.
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Affiliation(s)
- Mohammad S. Khuroo
- Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Srinagar, Kashmir, India
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12
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Bhandarwar A, Tandur A, Bharadwaj G, Chatnalkar S, Wagh A, Bakhshi G. Wandering parasite: endoscopic management of hydatid cysts of abdomen encroaching thorax. Surg Endosc 2021; 35:7253-7259. [PMID: 34410500 DOI: 10.1007/s00464-021-08682-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Minimal access surgery has opened avenues of hybrid approach for abdominal hydatid cysts extending into thorax. This approach of combined laparoscopy and thoracoscopy should be evaluated for its feasibility and efficacy. AIM Present prospective study was designed to highlight the feasibility and utility of endoscopic approach in the management of complex hydatid cyst of the liver and spleen extending into the thorax. MATERIAL AND METHODS Patients undergoing combined Laparoscopy and thoracoscopy for abdominal hydatid cysts extending into thorax over a period of 4 years were included in the study. Their clinical features, investigations, imaging, treatment and duration of hospital stay were studied. Clinical outcomes were assessed with respect to morbidity and mortality using Calvien Dindo scale. RESULTS A total of 15 patients were studied. All patients had thoracic hydatid cysts with liver involvement in 12, splenic involvement in 2, and both liver and spleen in 1 patient. The most common symptom was pain in the abdomen in 11 patients (73.3%) followed by lump in the abdomen in 2 patients (13.33%), and dyspnoea in 2 patients (13.33%). Computed Tomography was diagnostic in all patients. Most common type was Gomez type 1 (7 patients) followed by Gomez type II (3 Patient) and Gomez type III (2 patient). The mean operative time was 120 min. Mean hospital stay was 10 days. Pleural effusion being the commonest postoperative sequelae. CONCLUSION This endoscopic approach for liver and splenic hydatid cyst extending into thorax is feasible and averts morbidities of thoracotomy.
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Affiliation(s)
- Ajay Bhandarwar
- Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Amarjeet Tandur
- Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Guru Bharadwaj
- Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India.
| | - Soumya Chatnalkar
- Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Amol Wagh
- Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Girish Bakhshi
- Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
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13
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Govindaraj S, Bhadra V, Prakash C, Govindaraj S. Unusual case of disappearing hepatic hydatid cyst: COVID-19 times. BMJ Case Rep 2021; 14:14/8/e243533. [PMID: 34353833 PMCID: PMC8344285 DOI: 10.1136/bcr-2021-243533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The larvae of the tapeworm Echinococcus granulosus cause echinococcosis or hydatid disease. Liver is the most commonly involved organ accounting for 60%–80%. Rupture into the biliary radicle through a cystobiliary communication is the most anticipated complication seen in 5%–17%, presenting with obstructive jaundice and cholangitis. We present a young patient who had presented with cholangitis and a tender hepatomegaly. Contrast-enhanced CT (CECT) had revealed a large hepatic hydatid cyst with multiple daughter cysts and significant dilatation of intrahepatic/extrahepatic biliary system. He had undergone an emergency Endoscopic Retrograde Cholangiopancreatography (ERCP) with extraction of the membranes and stenting of the common bile duct. A few cycles of albendazole were given to sterilise before elective laparoscopic surgery. However, a follow-up CECT showed complete resolution of the hepatic hydatid with calcification. In conclusion, medical treatment with a few cycles of albendazole and ERCP with stenting could be a good treatment option.
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Affiliation(s)
- Shrenik Govindaraj
- Department of General and Laparoscopic Surgery, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Veera Bhadra
- Department of General and Laparoscopic Surgery, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Clement Prakash
- Department of General and Laparoscopic Surgery, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Sridar Govindaraj
- Department of General and Laparoscopic Surgery, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
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14
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Mönnink GLE, Stijnis C, van Delden OM, Spijker R, Grobusch MP. Percutaneous Versus Surgical Interventions for Hepatic Cystic Echinococcosis: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2021; 44:1689-1696. [PMID: 34272589 PMCID: PMC8550455 DOI: 10.1007/s00270-021-02911-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/22/2021] [Indexed: 12/16/2022]
Abstract
Purpose This systematic review and meta-analysis summarises the current literature on invasive treatment options of cystic hepatic echinococcosis (CE), comparing percutaneous radiological interventions to surgery, still the cornerstone of treatment in many countries. Methods A literature search was conducted in Medline and EMBASE databases (PROSPERO registration number: CRD42019126150). The primary outcome was recurrence of cysts after treatment. Secondary outcomes were complications, duration of hospitalisation, mortality and treatment conversion. Results The number of eligible prospective studies, in particular RCTs, was limited. In the four included studies, only conventional surgery is compared directly to percutaneous techniques. From the available data, in terms of recurrence, percutaneous treatment of hydatid cysts is non-inferior to open surgery. With regard to complications and length of hospital stay, outcomes favour percutaneous therapy. Conclusion Although evidence from prospective research is small, percutaneous treatment in CE is an effective, safe and less invasive alternative to surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-021-02911-4.
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Affiliation(s)
- G L E Mönnink
- Department of Infectious Diseases, Division of Internal Medicine, Center of Tropical Medicine and Travel Medicine, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - C Stijnis
- Department of Infectious Diseases, Division of Internal Medicine, Center of Tropical Medicine and Travel Medicine, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - O M van Delden
- Department of Radiology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R Spijker
- Medical Library, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Grobusch
- Department of Infectious Diseases, Division of Internal Medicine, Center of Tropical Medicine and Travel Medicine, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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15
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Treatment of Gharbi Type III Hepatic Hydatid Cysts: A Clinical Dilemma. Int Surg 2020. [DOI: 10.9738/intsurg-d-15-00103.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article aims to compare available treatment options for type III liver hydatid cysts, including surgery and percutaneous techniques. Hydatid disease is a helminthic infection caused by Echinococcus granulosus and is a serious public health problem in endemic regions of the world. Hydatid cyst of the liver is the most common clinical presentation of Echinococcus granulosus. According to Gharbi classification, hydatid cysts of the liver are classified into 5 types. Type III hydatid cysts are those with fluid collection and septa. Treatment of Gharbi type III hydatid cysts is still controversial. Some researchers think that Gharbi type III hydatid cysts are not suitable for percutaneous drainage, and surgery is the suitable treatment option. There are not enough prospective studies comparing percutaneous and surgical techniques for the treatment of type III hydatid disease of the liver. A proper meta-analysis does not seem to be possible with the available studies in current medical literature.
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16
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Kankilic N, Aydin MS, Günendi T, Göz M. Unusual Hydatid Cysts: Cardiac and Pelvic-Ilio femoral Hydatid Cyst Case Reports and Literature Review. Braz J Cardiovasc Surg 2020; 35:565-572. [PMID: 32865381 PMCID: PMC7454634 DOI: 10.21470/1678-9741-2019-0153] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Hydatid cyst is a parasitic disease caused by Echinococcus granulosus, most commonly seen in the liver and lungs. The hydatid cyst is rarely seen in the heart and iliofemoral region, representing less than 2% of all cases. In this article, we report our cases of hydatid cysts in unusual loci. Methods Between 2015 and 2018, 6 rare cases of hydatid cysts were diagnosed at the Cardiovascular Surgery Department of Harran University. Four of these patients had cardiac localization and two patients had their cysts located in the iliofemoral region, extending to the pelvic zone. All patients were female. Three patients had no other organ involvement. One patient with cardiac hydatid cyst underwent normothermic cardiopulmonary bypass + total pericystectomy + Cooley-like aneurysmectomy. Total pericystectomy was performed in three other patients with intrathoracic locus by normothermic cardiopulmonary bypass. Two patients who were referred to our clinic with palpable iliofemoral mass were evaluated with appropriate imaging methods and diagnosed accordingly. Multiple iliofemoral cysts were managed with pericystectomy and drainage by a single incision made over the inguinal ligament. Conclusion Hydatid cyst disease can develop in cardiac chambers and inguinal region with or without hepatic or pneumatic involvement. Normothermic cardiopulmonary bypass can be safely used in patients with cardiac hydatid cysts, and capitonnage similar to ventricular aneurysm repair in patients with a widely involved cystic lesion can be very useful for the protection of ventricular functions.
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Affiliation(s)
- Nazim Kankilic
- Department of Cardiovascular Surgery, Medical School of Harran University, Şanlıurfa, Turkey
| | - Mehmet Salih Aydin
- Department of Cardiovascular Surgery, Medical School of Harran University, Şanlıurfa, Turkey
| | - Tansel Günendi
- Department of Pediatric Surgery, Medical School of Harran University, Şanlıurfa, Turkey
| | - Mustafa Göz
- Department of Cardiovascular Surgery, Medical School of Harran University, Şanlıurfa, Turkey
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17
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Felsenreich DM, Rojas A, Gachabayov M, Quintero L, Da Eric Dong X. Robotic resection of hepatic echinococcal cysts: A video vignette. Asian J Surg 2020; 43:857. [PMID: 32527580 DOI: 10.1016/j.asjsur.2020.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Affiliation(s)
| | - Aram Rojas
- Westchester Medical Center, New York Medical College, Department of Surgery, 100 Woods Rd Taylor Pavilion D362 Valhalla, NY, 10595, USA
| | - Mahir Gachabayov
- Westchester Medical Center, New York Medical College, Department of Surgery, 100 Woods Rd Taylor Pavilion D362 Valhalla, NY, 10595, USA
| | - Luis Quintero
- Westchester Medical Center, New York Medical College, Department of Surgery, 100 Woods Rd Taylor Pavilion D362 Valhalla, NY, 10595, USA
| | - Xiang Da Eric Dong
- Westchester Medical Center, New York Medical College, Department of Surgery, 100 Woods Rd Taylor Pavilion D362 Valhalla, NY, 10595, USA
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18
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A comparative analysis of radical and non-radical surgical treatment of hydatid liver echinococcosis: a single-center analysis. Eur Surg 2020. [DOI: 10.1007/s10353-020-00642-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Abstract
Hepatosplenic candidiasis and other fungal infections of the liver are uncommon in healthy individuals; however, high index of suspicion is essential in immunocompromised patients with prolonged fever. Parasitic infections are protozoan or helminthic; their distribution and epidemiology are variable among different world regions. Clonorchiasis, opisthorchiasis, fascioliasis, and ascariasis are helminthic infections that commonly involve the biliary systems. Signs and symptoms of cholangitis require prompt management to relieve biliary obstruction; addition of antihelminthic agents is essential. Parasitic infections are mostly transmitted to humans by fecally contaminated food and water. Proper hand and food sanitation measures are essential in preventing disease transmission.
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Affiliation(s)
- Sirina Ekpanyapong
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - K Rajender Reddy
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Philadelphia, PA 19104, USA.
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20
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Comparison of the Long-Term Results of Puncture, Aspiration, Injection and Re-aspiration (PAIR) and Catheterization Techniques for the Percutaneous Treatment of CE1 and CE3a Liver Hydatid Cysts: A Prospective Randomized Trial. Cardiovasc Intervent Radiol 2020; 43:1034-1040. [DOI: 10.1007/s00270-020-02477-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/02/2020] [Indexed: 11/26/2022]
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21
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Şimşek G, Hasırcı İ, Ulutaş ME, Kartal A, Arslan K. Withdrawn: An innovative procedure: Laparoscopic sterilization of liver cyst cavities with foley catheter method. Am J Surg 2020:S0002-9610(20)30153-7. [PMID: 32718467 DOI: 10.1016/j.amjsurg.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
"This article has been withdrawn: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been withdrawn at the request of the editor and publisher. The publisher regrets that an error occurred which led to the premature publication of this paper. This error bears no reflection on the article or its authors. The publisher apologizes to the authors and the readers for this unfortunate error". The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Gürcan Şimşek
- University of Health Sciences, Konya Research and Training Hospital, Konya, Turkey.
| | - İsmail Hasırcı
- University of Health Sciences, Konya Research and Training Hospital, Konya, Turkey
| | - Mehmet Eşref Ulutaş
- University of Health Sciences, Konya Research and Training Hospital, Konya, Turkey
| | - Adil Kartal
- University of Health Sciences, Konya Research and Training Hospital, Konya, Turkey
| | - Kemal Arslan
- University of Health Sciences, Konya Research and Training Hospital, Konya, Turkey
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22
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Sokouti M, Sokouti M, Sokouti B. Intact Pulmonary Hydatid Cyst: Is Bronchoscopic Removal Possible? CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666190423145356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the current technical note, the structure of pulmonary hydatid cysts has been presented and the included layers have been discussed. Then, some critical notes have been provided for the management of intact pulmonary hydatid cyst which should not be removed by bronchoscopic approaches due to high rates of possible complications of tearing; however, it has been performed by some cases available in the literature which is not acceptable.
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Affiliation(s)
- Massoud Sokouti
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Sokouti
- Department of Cardiothoracic Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Sokouti
- Biotechnology Research Center, Tabriz University o f Medical Sciences, Tabriz, Iran
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23
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Mohammed AA, Arif SH. Surgical excision of a giant pedunculated hydatid cyst of the liver. J Surg Case Rep 2019; 2019:rjz208. [PMID: 31360435 PMCID: PMC6649717 DOI: 10.1093/jscr/rjz208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 06/12/2019] [Indexed: 12/23/2022] Open
Abstract
Hydatid disease is caused by a tape worm Echinococcus Granulosus that lives in the intestines of the definitive host which is the dog or other carnivore. Human is the accidental intermediate host and become infected by ingesting contaminated vegetables or water with the eggs of the parasite. A-37-year old male presented with right side abdominal pain for 2 months. Abdominal examination showed a large right side abdominal mass extending from the right subcostal region to the right iliac fossa. CT-scan showed two cystic lesions in the right lobe of the and a third one extending to the pelvis. During surgery aspiration of 10 liters of bile stained fluid done. Excision of the cysts done. Tube drain put inside the cyst cavity with omentoplasty. There was bile leak to the drain which stopped over one month. The patient received anthelminthic medication for 3 months.
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Affiliation(s)
- Ayad Ahmad Mohammed
- Department of Surgery, University of Duhok, College of Medicine, DUHOK, Kurdistan Region, Iraq
| | - Sardar Hassan Arif
- Department of Surgery, University of Duhok, College of Medicine, DUHOK, Kurdistan Region, Iraq
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24
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Boyce DSK, Ellis JS, Hightower SL, Lew JL, Price MW, Lin-Hurtubise KM, Hostler JM. Recurrent Inactive Hydatid Cyst of the Liver Causing Restrictive Pulmonary Physiology. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2019; 78:230-235. [PMID: 31475251 PMCID: PMC6697656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Hydatid and alveolar cysts are formed by the helminths Echinococcus granulosus and Echinococcus multilocularis, respectively, which are endemic to pastoral areas, and are more commonly found in South America, the Mediterranean, Russia, and China. Hydatid cysts can cause bacteremia, form abscesses, or cause mass effect by compressing surrounding organs. Strategies to prevent such complications include benzimidazoles, surgical resection, and Puncture, Aspiration, Injection and Re-aspiration (PAIR) procedure. A 71-year-old Egyptian man with remote history of Echinococcus infection one year status post PAIR procedure, presented with dyspnea on exertion. On exam, the patient had a palpable right upper quadrant mass. The patient had a known small hydatid liver cyst on prior ultrasound, however repeat imaging showed growth to 15×19×14cm, with right hemidiaphragm elevation, compressive atelectasis, and compression of the right atrium. He had no peripheral eosinophilia and negative echinococcal serology, consistent with remote infection. The patient underwent repeat PAIR procedure and 3L of serous fluid was drained from the cyst. Fluid analysis was negative for scolices, cysts or hooklets. His symptoms improved; however the cyst re-accumulated 1 month later. Total cystectomy was performed surgically by hepatic wedge resection, with permanent improvement in symptoms. This case is a rare example of Echinococcus infection causing significant respiratory morbidity requiring repeated invasive procedures and surgery, in the setting of inactive disease.
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Affiliation(s)
- Dacia S K Boyce
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI (DSKB, JSE, SLH, JML)
- Division of Infectious Disease, Tripler Army Medical Center, Honolulu, HI (MWP)
- Department of Surgery, Tripler Army Medical Center, Honolulu, HI (KML-H)
- Division of Pulmonary and Critical Care, Tripler Army Medical Center, Honolulu, HI (JMH)
| | - John S Ellis
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI (DSKB, JSE, SLH, JML)
- Division of Infectious Disease, Tripler Army Medical Center, Honolulu, HI (MWP)
- Department of Surgery, Tripler Army Medical Center, Honolulu, HI (KML-H)
- Division of Pulmonary and Critical Care, Tripler Army Medical Center, Honolulu, HI (JMH)
| | - Stephanie L Hightower
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI (DSKB, JSE, SLH, JML)
- Division of Infectious Disease, Tripler Army Medical Center, Honolulu, HI (MWP)
- Department of Surgery, Tripler Army Medical Center, Honolulu, HI (KML-H)
- Division of Pulmonary and Critical Care, Tripler Army Medical Center, Honolulu, HI (JMH)
| | - Jeffery L Lew
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI (DSKB, JSE, SLH, JML)
- Division of Infectious Disease, Tripler Army Medical Center, Honolulu, HI (MWP)
- Department of Surgery, Tripler Army Medical Center, Honolulu, HI (KML-H)
- Division of Pulmonary and Critical Care, Tripler Army Medical Center, Honolulu, HI (JMH)
| | - Michael W Price
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI (DSKB, JSE, SLH, JML)
- Division of Infectious Disease, Tripler Army Medical Center, Honolulu, HI (MWP)
- Department of Surgery, Tripler Army Medical Center, Honolulu, HI (KML-H)
- Division of Pulmonary and Critical Care, Tripler Army Medical Center, Honolulu, HI (JMH)
| | - Kevin M Lin-Hurtubise
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI (DSKB, JSE, SLH, JML)
- Division of Infectious Disease, Tripler Army Medical Center, Honolulu, HI (MWP)
- Department of Surgery, Tripler Army Medical Center, Honolulu, HI (KML-H)
- Division of Pulmonary and Critical Care, Tripler Army Medical Center, Honolulu, HI (JMH)
| | - Jordanna M Hostler
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI (DSKB, JSE, SLH, JML)
- Division of Infectious Disease, Tripler Army Medical Center, Honolulu, HI (MWP)
- Department of Surgery, Tripler Army Medical Center, Honolulu, HI (KML-H)
- Division of Pulmonary and Critical Care, Tripler Army Medical Center, Honolulu, HI (JMH)
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25
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Percutaneous Treatment of Giant Cystic Echinococcosis in Liver: Catheterization Technique in Patients with CE1 and CE3a. Cardiovasc Intervent Radiol 2019; 42:1153-1159. [DOI: 10.1007/s00270-019-02248-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/17/2019] [Indexed: 01/17/2023]
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26
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Fadel SA, Asmar K, Faraj W, Khalife M, Haddad M, El-Merhi F. Clinical review of liver hydatid disease and its unusual presentations in developing countries. Abdom Radiol (NY) 2019; 44:1331-1339. [PMID: 30306203 DOI: 10.1007/s00261-018-1794-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Human hydatid cyst disease is an international public health issue that particularly affects the developing countries. In this article, we discuss the epidemiology of hydatid disease in third world countries, the life cycle of echinococcus granulosus and how to make the clinical diagnosis of the disease, including laboratory tests and imaging modalities as well as uncommon presentation of this entity that we have encountered at the American University of Beirut Medical Center (AUBMC). We emphasize on the new World Health Organization classification of hepatic echinococcosis with examples from our clinical practice at AUBMC, and finally we describe the treatment, including medical and interventional therapies.
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Affiliation(s)
- Sandra Abi Fadel
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karl Asmar
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Walid Faraj
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad Khalife
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maurice Haddad
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi El-Merhi
- Diagnostic Radiology Department, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
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27
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Sokouti M, Sadeghi R, Pashazadeh S, Abadi SEH, Sokouti M, Ghojazadeh M, Sokouti B. A systematic review and meta-analysis on the treatment of liver hydatid cyst using meta-MUMS tool: comparing PAIR and laparoscopic procedures. Arch Med Sci 2019; 15:284-308. [PMID: 30899281 PMCID: PMC6425195 DOI: 10.5114/aoms.2018.73344] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/20/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There is an academic debate over surgical treatments of liver hydatid cyst disease. In this study, a systematic review and meta-analysis were carried out in order to evaluate the pros and cons of both PAIR (Puncture, Aspiration, Injection, Respiration) and laparoscopic techniques by considering the outcomes of liver hydatid cysts. MATERIAL AND METHODS We designed descriptive Boolean queries to search two databases, PubMed and Scopus, to derive the articles published in the period of January 2000 to December 2016 in order to evaluate the outcomes of these research articles. The outcomes of laparoscopic and PAIR procedures include the rates of cure, postoperative complications, recurrences, and mortality, which were extracted, assessed, and used as their corresponding effect sizes. RESULTS Fifty-seven studies including a total of 2832 patients (PAIR group n = 1650 and laparoscopic group = 1182) were analyzed. In this meta-analysis study, a random effect model of correlations of outcomes (postoperative complications, mortalities, recurrences, and cure rates) of PAIR and laparoscopy procedures was used. The meta-analysis and the forest plots of the two procedures show that the PAIR approach is superior in terms of cure, complication, and mortality rates compared with the laparoscopy technique. However, the recurrence rate is low in laparoscopic approaches. Moreover, Egger's tests for determining publication bias and heterogeneity tests were also performed. CONCLUSIONS This study shows promising trends toward an advantage of PAIR procedures in treatment of liver hydatid cyst in comparison with laparoscopic procedures. The PAIR procedure is superior to laparoscopy due to having a higher cure rate and lower complication and mortality rates; however, the latter has a lower recurrence rate.
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Affiliation(s)
- Massoud Sokouti
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Pashazadeh
- Department of Computer and Electrical Engineering, University of Tabriz, Tabriz, Iran
| | - Saeed Eslami Hasan Abadi
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Sokouti
- Department of Cardiothoracic Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Sokouti
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Comparison of Laparoscopic and Conventional Cystotomy/Partial Cystectomy in Treatment of Liver Hydatidosis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1212404. [PMID: 30868067 PMCID: PMC6379859 DOI: 10.1155/2019/1212404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/19/2018] [Accepted: 01/17/2019] [Indexed: 02/07/2023]
Abstract
Introduction Hydatidosis is a zoonotic infection and treatment is mandatory to avoid complications. Surgery remains the first choice in the treatment especially for CE2-CE3b cysts. Open or laparoscopic approaches are available. However, comparative studies are limited. Materials and Methods Data of patients who underwent cystotomy/partial cystectomy for liver hydatidosis between January 2012 and September 2016 (n=77) were evaluated retrospectively. Recurrent cases and the patients with previous hepatobiliary surgery were excluded. 23 patients were operated upon laparoscopically and named as Group 1. 48 patients operated conventionally named as Group 2. Demographics, cyst characteristics, operative time, length of hospital stay, recurrences, and surgery related complications were evaluated. Results Groups were similar in terms of demographics, cyst characteristics, and operative time. The length of hospital stay was 3.4 days in Group 1 and 4.7 days in Group 2 (p=0,007). The mean follow-up period was 17.8 months and 21.7 months, respectively (p=0.170). Overall complication rates were similar in two groups (p=0.764). Three conversion cases occurred (13%). One mortality was seen in Group 2. Four recurrences occurred in each group (17% versus 8.3%, respectively) (p=0.258). Conclusions Laparoscopy is a safe and feasible approach for surgical treatment of liver hydatidosis. Recurrence may be prevented by selection of appropriate cases in which exposure of cysts does not pose an intraoperative difficulty.
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Gandhi S, Das B, Basu R, Dey S. Single-centre experience in treatment of multiple-site hydatid disease in a tertiary care centre of Eastern India. Indian J Thorac Cardiovasc Surg 2018; 35:461-467. [PMID: 33061031 DOI: 10.1007/s12055-018-0743-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 09/01/2018] [Accepted: 09/13/2018] [Indexed: 01/03/2023] Open
Abstract
Background Single-stage surgery for multiple-site hydatid cysts especially for the lung and liver is a less performed approach. Objective The aim of the study is to assess the feasibility of this approach in terms of outcome. Methods We studied 42 patients with multiple-site hydatid cysts over a period of 36 months admitted or referred to the department of CTVS of a tertiary-level hospital of Eastern India. Results Maximum numbers of cases were found in the age group of 11-20 years comprising 35.71% of the patient population with a female preponderance (18 versus 24). Chest pain was the commonest presenting feature (66.66%) followed by cough (52.38%), haemoptysis and dyspnoea 33.33% respectively. Eosinophilia was observed in four patients (9.52%). Twenty-two patients had simultaneous occurrence of pulmonary and hepatic hydatid disease (52.38%). Fourteen patients had only pulmonary involvement (33.33%). Chest wall (including the parietal pleura) was involved in six patients (14.28%). 23.03% patients presented with complicated cysts in the form of rupture into the pleura (19.35%) or the peritoneum (9.68%). Eighteen patients (42.86%) were operated via posterolateral thoracotomy and 18 (42.86%) were operated via thoracotomy with phrenotomy. Twenty-four patients (57.14%) underwent cyst excision by Barrett's technique. 59.09% patients underwent cystostomy for hepatic hydatids and five underwent omental packing (22.72%). Prolonged air leak was the commonest complication (35.71%). The mean operative time for thoracotomy was 136.87 min (~ 140 min) and 145 min for thoracotomy with phrenotomy. Only five patients (11.9%) required a prolonged intensive -treatment unit (ITU) stay of > 2 days and four had prolonged hospital stay > 15 days (1 of bronchopleural fistula, 1 of anaphylactic shock and 1 of bilateral lung cyst excision with postoperative lobar collapse). Conclusion Single-stage surgery is a viable option for multiple- and multi-site hydatids.
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Affiliation(s)
- Shilpa Gandhi
- Department of CTVS, RG Kar Medical College, Kolkata, India
- DNB Thoracic Surgery, Plot No. 208, 2nd Floor, Abhyankar Nagar, Nagpur, Maharashtra 440010 India
| | - Bhaskar Das
- Department of CTVS, RG Kar Medical College, Kolkata, India
| | - Rajarshi Basu
- Department of CTVS, RG Kar Medical College, Kolkata, India
| | - Subrata Dey
- Department of CTVS, RG Kar Medical College, Kolkata, India
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Percutaneous US-guided combined ethanol and tetracycline injection for treating symptomatic simple and hydatid hepatic cysts. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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El-Gendi AM, El-Shafei M, Bedewy E. The Role of Prophylactic Endoscopic Sphincterotomy for Prevention of Postoperative Bile Leak in Hydatid Liver Disease: A Randomized Controlled Study. J Laparoendosc Adv Surg Tech A 2018; 28:990-996. [PMID: 29641366 DOI: 10.1089/lap.2017.0674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Bile leak is the main cause of morbidity and mortality after surgery for hydatid liver cysts. Aim was to assess the role of prophylactic endoscopic sphincterotomy (ES) in reducing postoperative bile leak in patients undergoing partial cystectomy. METHODS Fifty-four patients with hepatic hydatid cyst met inclusion criteria, 27 were excluded or declined to participate. Twenty-six women and 28 men (mean age 44.6 ± 10.1, range: 22-61 years) were randomly assigned to either group I with ES (n = 27) or group II without ES (n = 27). RESULTS Demographics and clinical, laboratory, and radiological characteristics of cysts were not statistically different between two groups. Group I had a significant decrease in bile leak rate compared with group II (11.1% versus 40.7%, P = .013), with significantly shorter duration of hospital stay (P < .0001). Biliary fistula in group I had significantly lower daily output (100 mL/day versus 350 mL/day) with gradual reduction till stoppage of leak in 3-4 days without intervention. Biliary fistula in group II had a significantly higher need for biliary intervention through postoperative endoscopic retrograde cholangiopancreatography with ES compared with biliary fistula in group I (FEP = .002), with significantly longer mean time of fistula closure (P = .011) and longer time to drain removal (P < .0001). Nonbiliary complications were comparable between two groups. CONCLUSION Prophylactic ES provides significant reduction in postoperative bile leak rate with shorter hospital stay after partial cystectomy of hydatid cyst. Biliary fistula in patients with ES has significantly lower daily output with shorter time of drain removal and shorter time to closure than patients without ES.
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Affiliation(s)
- Ahmed M El-Gendi
- 1 Department of Surgery, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mohamed El-Shafei
- 2 Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Essam Bedewy
- 3 Department of Hepatology and Tropical Medicine, Faculty of Medicine, Alexandria University , Alexandria, Egypt
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Azadi MDA, Hassanajili S, Zarrabi K, Sarkari B. Solidification of hydatid cyst fluid with an injectable chitosan/carboxymethylcellulose/β-glycerophosphate hydrogel for effective control of spillage during aspiration of hydatid cysts. Prog Biomater 2018; 7:35-54. [PMID: 29460180 PMCID: PMC5823813 DOI: 10.1007/s40204-018-0082-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/24/2018] [Indexed: 12/05/2022] Open
Abstract
Cystic echinococcosis (CE)/hydatid cyst is one of the most important helminthic diseases in the world. The treatment of hydatid cyst ranges from surgical intervention to chemotherapy, although the efficacy of chemotherapy is still unclear. Postoperative complication which results from the spillage of cysts during surgical operation is one of the most important concerns in surgical treatment of hydatid cyst. The aim of the current study was to solidify the hydatid cyst fluid (HCF) with an injectable and thermosensitive chitosan (CS)/carboxymethyl cellulose (CMC)/β-glycerol phosphate (BGP) hydrogel for effective control of spillage during the aspiration of hydatid cysts. Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), water uptake, rheological analysis, and Alamar Blue cytotoxicity assay were employed to characterize the hydrogel. A five level with three times replication at the central point using a central composite design (CCD), which is a response surface methodology (RSM), was used to optimize the experimental conditions. Assessment of the produced hydrogel showed that the intermolecular interactions of amino groups of chitosan and hydrogen groups of CMC were correctively established and appreciable swelling with a good strength was obtained. Hydrogels morphology had a porous structure. Rheological analysis showed that CS/CMC/BGP blends had a phase transition (32-35 °C) of sol-gel close to the body temperature. Alamar Blue cytotoxicity assay showed that CS (1.75%)/CMC (1.4%)/BGP (2.9%) had IC50 values of 0.598, 0.235 and 0.138 (µg/µL) for 24, 48 and 72 h, which indicated that the produced polymer solution had no significant cytotoxic effect for human fibroblast cell line. In vitro injection of the polymer solution of CS/CMC/BGP with CS/CMC ratio of 1.75/1.4 was done on HCF (1 mL polymer solution to 3 mL of HCF) at 37 °C with a final concentration of 2.9% for BGP resulting in solidification of HCF in less than 45 min.
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Affiliation(s)
- Mostafa D A Azadi
- Department of Chemical Engineering, School of Chemical and Petroleum Engineering, Shiraz University, Shiraz, Iran
| | - Shadi Hassanajili
- Department of Chemical Engineering, School of Chemical and Petroleum Engineering, Shiraz University, Shiraz, Iran.
| | - Khalil Zarrabi
- Department of Cardiovascular Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahador Sarkari
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Pang Q, Jin H, Man Z, Wang Y, Yang S, Li Z, Lu Y, Liu H, Zhou L. Radical versus conservative surgical treatment of liver hydatid cysts: a meta-analysis. Front Med 2017; 12:350-359. [PMID: 29170917 DOI: 10.1007/s11684-017-0559-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 05/03/2017] [Indexed: 12/12/2022]
Abstract
To date, the efficacy of radical surgery (RS) versus conservative surgery (CS) for liver hydatid cysts (LHC) remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Embase, and Web of Science were searched from their inceptions until June 2016. Meta-analysis was performed using STATA 12.0 software. We identified 19 eligible studies from 10 countries by retrieval. In total, 1853 LHC patients who received RS were compared with 2274 patients treated by CS. The risk of postoperative overall complication, biliary fistula, and recurrence was significantly lower, and operation time was significantly longer in the RS group. However, no statistically significant differences were found in terms of mortality risk and the duration of hospital stay between RS and CS. No significant publication biases were observed in all the above analyses. In conclusion, RS reduces the rates of postoperative complications and recurrence, whereas no trend toward such a reduction in mortality was observed in LHC patients.
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Affiliation(s)
- Qing Pang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Hao Jin
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Zhongran Man
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Yong Wang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Song Yang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Zongkuang Li
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Yimin Lu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Huichun Liu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China.
| | - Lei Zhou
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China.
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Bakdik S, Arslan S, Oncu F, Tolu I, Eryilmaz MA. Percutaneous treatment of hepatic cystic echinococcosis: the success of alcohol as a single endocavitary agent in PAIR, catheterization, and modified catheterization techniques. Radiol Med 2017; 123:153-160. [PMID: 29030721 DOI: 10.1007/s11547-017-0820-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/28/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This retrospective study aims at demonstrating the success rate, effectiveness, and advantages of alcohol as a scolicidal and sclerosing agent for the percutaneous treatment of liver hydatid cysts. METHODS A total of 554 liver hydatid cysts obtained from 347 patients admitted between January 2008 and February 2016 were retrospectively investigated. Of these, 435 (78.5%), 91 (16.4%), and 28 (5%) were classified as Gharbi type 1, 2, and 3, respectively. Type 1 and 2 cysts were treated using PAIR (puncture, aspiration, injection, respiration) and single puncture catheterization methods; type 3 lesions were treated using a modified catheterization technique. Alcohol was used as a scolicidal and sclerosing agent in all procedures. RESULTS After excluding three lesions (0.5%) because of lack of parenchymal support during catheterization, 274 (49.7%), 250 (45.3%), and 27 (4.9%) of 551 lesions were treated with PAIR, single puncture catheterization, and modified catheterization techniques, respectively. Therefore, a 99.5% of technical success rate was obtained. Major complications in 2 patients (0.5%) and minor complications were observed in 36 patients (10.3%). Mean hospital stay was 1.55±2.3 days (range: 0-23 days). Patients were followed-up for mean 19.6 months (range: 6-83 months), during which recurrences were detected in 19 patients (5.4%). CONCLUSIONS The use of alcohol as a scolicidal and sclerosing agent during the percutaneous treatment of liver hydatid cysts is associated with a high success rate and low rates of recurrence and complications, and should be considered an important alternative to surgical procedures.
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Affiliation(s)
- Suleyman Bakdik
- Department of Radiology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Serdar Arslan
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey.
| | - Fatih Oncu
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Ismet Tolu
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Mehmet Ali Eryilmaz
- Department of General Surgery, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
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Sokouti M, Sadeghi R, Pashazadeh S, Abadi SEH, Sokouti M, Rezaei-Hachesu P, Ghojazadeh M, Sokouti B. A systematic review and meta-analysis on the treatment of liver hydatid cyst: Comparing laparoscopic and open surgeries. Arab J Gastroenterol 2017; 18:127-135. [PMID: 28988788 DOI: 10.1016/j.ajg.2017.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/29/2017] [Accepted: 09/17/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND STUDY AIMS There is an academic debate regarding surgical interventions for liver hydatid cyst disease. The purpose of the current systematic review and meta-analysis study was to analyse the pros and cons of open surgery and laparoscopic techniques, considering the outcomes of liver hydatid cysts. METHODS Descriptive Boolean queries were used to search PubMed and Scopus for articles published between January 2000 and December 2016 to evaluate the outcomes of liver hydatid cyst in terms of mortality, post-operative complications, cure rate and recurrences. The data related to the four outcomes of liver hydatid cyst were extracted, assessed and then used as their corresponding effect sizes in the meta-analysis process. RESULTS Six studies totally consisting of 1028 patients [open surgery group=816 (+7 converted to lap) and laparoscopic group=212] were analysed. In this meta-analysis study, random effects models of outcomes (i.e. post-operative complications, mortalities, recurrences and cure rate) of the two procedures were OR=0.852, LL=0.469, UL=1.546, Z=-0.526, p=0.599 (for post-operative complications); OR=0.849, LL=0.141, UL=5.105, Z=-0.179, p=0.858 (for mortality); OR=0.903, LL=0.166, UL=4.906, Z=-0.119, p=0.906 (for recurrence); and OR=0.459, LL=0.129, UL=1.637, Z=-1.201, p=0.230 (for cure rate). Meta-analysis and illustrated forest plots showed that there are no superiorities between the two approaches. The results of heterogeneity tests of the above mentioned outcomes were Q=8.083, df=5, p=0.152, I2=38.142% for post-operative complications; Q=0.127, df=2, p=0.938, I2=0% for mortality; Q=4.984, df=2, p=0.083, I2=59.874% for recurrence; and Q=10.639, df=5, p=0.059, I2=53.001% for cure rate. The results of regression tests based on Egger's, smoothed variance based on Egger (SVE) and smoothed variance based on Thomson (SVT) showed that the p values are not significant, and there are neither significant statistical differences nor publication bias between the outcomes of the two treatment procedures. CONCLUSION The results show no promising trends towards advantages of open versus laparoscopic surgeries in the treatment of liver hydatid cyst. However, informative measurement values for comparing these surgeries could be derived for complications, recurrence, mortality and cure rates. Furthermore, all three tests, namely Egger's, SVE and SVT regression models, were used to assess publication bias and showed no evidence for the existence of publication bias.
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Affiliation(s)
- Massoud Sokouti
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Saeid Pashazadeh
- Faculty of Computer and Electrical Engineering, University of Tabriz, Tabriz, Iran
| | - Saeed Eslami Hasan Abadi
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Sokouti
- Department of Cardiothoracic Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Peyman Rezaei-Hachesu
- Department of Health Information Technology, School of Health Management and Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Sokouti
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Surgical treatment of hepatic Echinococcus granulosus. GASTROENTEROLOGY REVIEW 2017; 12:199-202. [PMID: 29123581 PMCID: PMC5672708 DOI: 10.5114/pg.2017.70473] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/29/2016] [Indexed: 12/14/2022]
Abstract
Introduction Infections caused by metacestode stage of the Echinococcus granulosus in humans result in disease named cystic echinococcosis. Aim To present the outcomes of patients treated surgically for cystic echinococcosis of the liver. Material and methods One hundred and nineteen patients treated in the period between 1989 and 2014 due to E. granulosus infection in the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw were selected for this retrospective study. Diagnostic protocol included imaging examinations, i.e. ultrasonography and computed tomography of the abdomen. Blood samples where used to proceed sequential enzyme-linked immunosorbent assay (ELISA) using Em2plus antigen as well as polymerase chain reaction (PCR) to detect E. granulosus. Results Surgery was the choice for treatment for almost all of the patients (98.3%). In 40 (34.2%) patients right hemihepatectomy, in 19 (16.2%) patients left hemihepatectomy, and in 21 (17.9%) patients bisegementectomy were performed. Postoperative complications occurred in 4 (3.4%) patients. In 3 patients biliary fistula requiring endoscopic treatment was observed, and 1 patient had subdiaphragmatic abscess successfully treated with drainage under ultrasound guidance. None of the patients died in the postoperative period, and the 1-, 5-, and 10-year survival rates were 100.0%, 90.9%, and 87.9%, respectively. Conclusions Surgical treatment of the symptomatic cystic echinococcosis is the modality of choice for E. granulosus infection of the liver. Despite substantial development of diagnostic methods and new management opportunities, echinococcal infection still presents a challenge for epidemiologists, pharmacologists, and clinicists.
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Movahedi F, Li L, Gu W, Xu ZP. Nanoformulations of albendazole as effective anticancer and antiparasite agents. Nanomedicine (Lond) 2017; 12:2555-2574. [PMID: 28954575 DOI: 10.2217/nnm-2017-0102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Initially emerging as a widely used clinical antiparasitic drug, albendazole (ABZ) has been increasingly recognized as an effective anticancer agent due to its outstanding advantage, in other words, low toxicity to normal cells but high effectiveness against parasites and some tumors. The major challenge is its poor water solubility and subsequently low bioavailability. This article thus first reviews the brief achievements in using ABZ to treat parasites and cancers, and summarizes the basic mechanisms of action of ABZ. Then this article critically reviews recent nanotechnological strategies, in other words, formulating/conjugating it with carriers into nanoformulations, in practices of improving aqueous solubility and efficacy in treatment of tumors and parasites. Our expert opinions in this field are provided for more effective delivery of ABZ to treat tumors and parasites in vivo.
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Affiliation(s)
- Fatemeh Movahedi
- Australian Institute for Bioengineering & Nanotechnology, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Li Li
- Australian Institute for Bioengineering & Nanotechnology, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Wenyi Gu
- Australian Institute for Bioengineering & Nanotechnology, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Zhi Ping Xu
- Australian Institute for Bioengineering & Nanotechnology, The University of Queensland, St Lucia, QLD 4072, Australia
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Firpo G, Vola A, Lissandrin R, Tamarozzi F, Brunetti E. Preliminary Evaluation of Percutaneous Treatment of Echinococcal Cysts without Injection of Scolicidal Agent. Am J Trop Med Hyg 2017; 97:1818-1826. [PMID: 29016329 DOI: 10.4269/ajtmh.17-0468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Puncture, Aspiration, Injection of scolicidal agent, Re-aspiration is the most widely used percutaneous treatment of cystic echinococcosis (CE). Among its perceived risks is chemical sclerosing cholangitis, a serious complication due to the caustic effect of the scolicidal solution on the biliary tree, when a patent cystobiliary fistula occurs. To simplify the protocol, we decided to omit injection and reaspiration of the scolicidal agent and to implement a full course of albendazole (ABZ) therapy instead of the routine 1-month ABZ prophylaxis. We searched our databases for patients with CL (Cystic Lesion, suspected for CE), CE1, and CE3a cysts treated between October 2007 and January 2017 with percutaneous aspiration followed by at least 1 month of oral ABZ and with an ultrasound follow-up of at least 6 months. Fifteen patients matched our inclusion criteria. Follow-up ranged from 7 to 75 months. The oral ABZ course after the aspiration procedure ranged from 1 to 18 months. Eleven subjects (73.3%) had undergone a course of ABZ before the percutaneous procedure (min 15 days, max 16 months). Ten cysts (62.5%) had reached solidification (stage CE4) in 3 to 69 months. Four other cysts (26.7%) remained stable in stage CE3a, whereas two cysts (13.3%) reactivated to stage CE3b. Procedural perioperative complications occurred in 13.3% of patients, whereas complications during the follow-up occurred in 20% of patients. These proof-of-concept preliminary results are overall comparable with those reported in the literature for other percutaneous treatments, both in terms of response rate, relapse rate, and morbidity.
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Affiliation(s)
- Giovanni Firpo
- WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Ambra Vola
- Division of Infectious Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy.,WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Raffaella Lissandrin
- Division of Infectious Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy.,WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Francesca Tamarozzi
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,Division of Infectious Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy.,WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
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Botsa E, Thanou I, Nikas I, Thanos L. Treatment of Hepatic Hydatid Cyst in a 7-Year-Old Boy Using a New Type of Radiofrequency Ablation Electrode. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:953-958. [PMID: 28871077 PMCID: PMC5595407 DOI: 10.12659/ajcr.904432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patient: Male, 7 Final Diagnosis: Echinococcosis Symptoms: Cough • fever Medication: — Clinical Procedure: Medical treatment and RFA of liver cyst Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Evanthia Botsa
- First Pediatric Clinic, National and Kapodistrian University of Athens, Agia Sofia Children's Hospital, Thivon and Levadias, Goudi, Athens, Greece
| | - Ioanna Thanou
- Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, Athens, Greece
| | - Ioannis Nikas
- Department of Medical Imaging and Interventional Radiology, Agia Sofia Children's Hospital, Thivon and Levadias, Goudi, Athens, Greece
| | - Loukas Thanos
- Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, Athens, Greece
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Shera TA, Choh NA, Gojwari TA, Shera FA, Shaheen FA, Wani GM, Robbani I, Chowdri NA, Shah AH. A comparison of imaging guided double percutaneous aspiration injection and surgery in the treatment of cystic echinococcosis of liver. Br J Radiol 2017; 90:20160640. [PMID: 28124569 DOI: 10.1259/bjr.20160640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To compare the results and complications of treatment by double percutaneous aspiration injection (DPAI) in cystic echinococcosis (CE) of the liver with those of surgery. To the best of our knowledge, such a study has not been carried out till date. METHODS From November 2012 to November 2015, 43 patients were randomly allocated to DPAI group (n = 22) and surgery group (n = 21). After the intervention, patients were evaluated monthly for 3 months, then at the sixth month and 6 monthly thereafter. RESULTS Average hospital stay was 2.38 days in DPAI group and 8.23 days in the surgery group. Response to DPAI was categorized as successful in 95.3% (n = 20) patients and incomplete in 4.7% (n = 1) patients. Response to surgery was characterized as successful in 85.7% (n = 18) patients and incomplete in 4.7% (n = 1) patients, and recurrence was seen in 9.5% (n = 2) patients. Using a 10% margin for non-inferiority, treatment response in the DPAI group was non-inferior to that of the surgery group. In the DPAI group, 19 patients had no complications, minor complications were seen in 4.7% (n = 1) patients and a major complication was seen in 4.7% (n = 1) patients. In the surgery group, no complications were seen in 13 patients, major complications were seen in 28.57% (n = 6) patients and minor complications were seen in 9.5% (n = 2) patients. CONCLUSION Over a follow-up period of 3 years, DPAI is non-inferior to surgery in the treatment of CE of the liver, while there is a statistically significant difference in the hospital stay and occurrence of complications. Advances in knowledge: DPAI offers advantages such as a short hospital stay, minimal invasiveness and morbidity, while being non-inferior to surgery. Total Immunoglobulin G antibody titres have limited utility in follow-up of patients treated.
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Affiliation(s)
- Tahleel A Shera
- 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India
| | - Naseer A Choh
- 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India
| | - Tariq A Gojwari
- 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India
| | - Faiz A Shera
- 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India
| | - Feroze A Shaheen
- 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India
| | - Ghulam M Wani
- 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India
| | - Irfan Robbani
- 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India
| | | | - Altaf H Shah
- 3 Department of Gastroentrology, SKIMS, Srinagar, India
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Nayman A, Guler I, Keskin S, Erdem TB, Borazan H, Kucukapan A, Ozbiner H, Batur A, Ertekin E, Feyzioglu B, Koc O, Kaya HE, Temizoz O, Kartal A, Ozbek O. A novel modified PAIR technique using a trocar catheter for percutaneous treatment of liver hydatid cysts: a six-year experience. Diagn Interv Radiol 2017; 22:47-51. [PMID: 26574902 DOI: 10.5152/dir.2015.15011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE We aimed to demonstrate the success and reliability of a novel puncture, aspiration, injection, and reaspiration (PAIR) technique in liver hydatid cysts. METHODS Percutaneous treatment with ultrasonographic guidance was performed in 493 hepatic hydatid cysts in 374 patients. Patients were treated with a new PAIR technique by single puncture method using a 6F trocar catheter. The results of this novel technique were evaluated with regards to efficacy and safety of the procedure and complication rates. RESULTS Out of 493 cysts, 317 were Gharbi type I (WHO CE 1) and 176 were Gharbi type II (WHO CE 3A). Of all cysts, 13 were referred to surgery because of cystobiliary fistulization. Recurrence was observed in 11 cysts one month later. Therefore, the success rate of the PAIR technique was 97.7% (469/480). Minor complications (fever, urticaria-like reactions, biliary fistula) were seen in 44 treated patients (12%, 44/374); the only major complication was reversible anaphylactic shock which was observed in two patients (0.5%, 2/374). CONCLUSION This novel modified PAIR technique may be superior to catheterization by Seldinger technique due to its efficiency, easier application, lower severe complication rate, and lower cost. Further comparative studies are required to confirm our observations.
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Affiliation(s)
- Alaaddin Nayman
- Department of Radiology, Selçuk University School of Medicine, Konya, Turkey.
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Kern P, Menezes da Silva A, Akhan O, Müllhaupt B, Vizcaychipi KA, Budke C, Vuitton DA. The Echinococcoses: Diagnosis, Clinical Management and Burden of Disease. ADVANCES IN PARASITOLOGY 2017; 96:259-369. [PMID: 28212790 DOI: 10.1016/bs.apar.2016.09.006] [Citation(s) in RCA: 273] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The echinococcoses are chronic, parasitic diseases that are acquired after ingestion of infective taeniid tapeworm eggs from certain species of the genus Echinococcus. Cystic echinococcosis (CE) occurs worldwide, whereas, alveolar echinococcosis (AE) is restricted to the northern hemisphere, and neotropical echinococcosis (NE) has only been identified in Central and South America. Clinical manifestations and disease courses vary profoundly for the different species of Echinococcus. CE presents as small to large cysts, and has commonly been referred to as 'hydatid disease', or 'hydatidosis'. A structured stage-specific approach to CE management, based on the World Health Organization (WHO) ultrasound classification of liver cysts, is now recommended. Management options include percutaneous sterilization techniques, surgery, drug treatment, a 'watch-and-wait' approach or combinations thereof. In contrast, clinical manifestations associated with AE resemble those of a 'malignant', silently-progressing liver disease, with local tissue infiltration and metastases. Structured care is important for AE management and includes WHO staging, drug therapy and long-term follow-up for at least a decade. NE presents as polycystic or unicystic disease. Clinical characteristics resemble those of AE, and management needs to be structured accordingly. However, to date, only a few hundreds of cases have been reported in the literature. The echinococcoses are often expensive and complicated to treat, and prospective clinical studies are needed to better inform case management decisions.
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Affiliation(s)
- P Kern
- University Hospital of Ulm, Ulm, Germany
| | | | - O Akhan
- Hacettepe University, Ankara, Turkey
| | - B Müllhaupt
- University Hospital of Zurich, Zürich, Switzerland
| | - K A Vizcaychipi
- National Institute of Infectious Diseases, Buenos Aires, Argentina
| | - C Budke
- Texas A&M University, College Station, TX, United States
| | - D A Vuitton
- Université de Franche-Comté, Besançon, France
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Cherradi Y, Afifi R, Khannoussi W, Firwana M, Rahaoui A, Benazzouz M, Essaid A. Long-Term Results of Percutaneous Management of Liver Hydatid Cysts: - Experience of a University Hospital in Endemic Region. JOURNAL OF MEDICAL AND SURGICAL RESEARCH 2016. [DOI: 10.46327/msrjg.1.000000000000077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and objective: Surgery was considered for years the standard treatment for all stages of liver hydatid cysts (LHC). Percutaneous treatment has becomes a fast, reliable and more efficient method in selected cases. The purpose of this study is to evaluate the effectiveness of percutaneous treatment of LHC on the basis of our department long-term results.
Patients and Methods: This study includes all patients who benefited from percutaneous treatment for LHC from December 1998 to April 2012. Puncture aspiration, injection, and re-aspiration (PAIR) were used for hydatid cysts smaller than 6 cm. Larger cysts, infected cysts and those with biliary fistula were treated by puncture associated to drainage (PA-PD). Absolute alcohol was used as sclerosing agent. Reduction of the size of the cyst more than 50%, pseudo-tumour echo pattern and disappearance of the cyst at the follow-up were retained as criteria of treatment efficacy.
Results: Two hundred thirty patients (136 female and 94 male; mean age: 35 years old) with 278 LHC underwent percutaneous treatment. Mean initial cyst diameter was 76.8 mm [20-180 mm]. According to Gharbi's classification, types I and II LHC accounted for 74% and 25% respectively. Fourteen patients (6%) presented with an infected cavity and 27 patients (12%) had a biliary fistula at diagnosis (12%). PA-PD was initially performedin 23 patients. No mortality, abdominal dissemination, or tract seeding occurred. Minor complications like urticaria, cutaneous rash and fever were reported in 24 patients (10%). One case of anaphylactic shock was reported with good evolution. Mean hospitalization time was 3 days ± 1.5 for uncomplicated cases and 16.5 days± 4.2 for complicated cases. 229 out of 230 patients were cured, whereas one recurrence has been reported.
Conclusion: Percutaneous treatmentis efficient and safe and offers complete cure in selected patients with the advantage of short hospitalization.
Keywords: Drainage, Hydatid Cyst, Liver, Morocco, Percutaneous Puncture, Ultrasound (US)
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Unexpected hosts: imaging parasitic diseases. Insights Imaging 2016; 8:101-125. [PMID: 27882478 PMCID: PMC5265192 DOI: 10.1007/s13244-016-0525-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/08/2016] [Accepted: 09/28/2016] [Indexed: 12/28/2022] Open
Abstract
Radiologists seldom encounter parasitic diseases in their daily practice in most of Europe, although the incidence of these diseases is increasing due to migration and tourism from/to endemic areas. Moreover, some parasitic diseases are still endemic in certain European regions, and immunocompromised individuals also pose a higher risk of developing these conditions. This article reviews and summarises the imaging findings of some of the most important and frequent human parasitic diseases, including information about the parasite's life cycle, pathophysiology, clinical findings, diagnosis, and treatment. We include malaria, amoebiasis, toxoplasmosis, trypanosomiasis, leishmaniasis, echinococcosis, cysticercosis, clonorchiasis, schistosomiasis, fascioliasis, ascariasis, anisakiasis, dracunculiasis, and strongyloidiasis. The aim of this review is to help radiologists when dealing with these diseases or in cases where they are suspected. Teaching Points • Incidence of parasitic diseases is increasing due to migratory movements and travelling. • Some parasitic diseases are still endemic in certain regions in Europe. • Parasitic diseases can have complex life cycles often involving different hosts. • Prompt diagnosis and treatment is essential for patient management in parasitic diseases. • Radiologists should be able to recognise and suspect the most relevant parasitic diseases.
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Evaluation and Comparison of the Early Outcomes of Open and Laparoscopic Surgery of Liver Hydatid Cyst. Surg Laparosc Endosc Percutan Tech 2016; 25:403-7. [PMID: 26429050 DOI: 10.1097/sle.0000000000000199] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Surgery is the mainstay for treatment of liver hydatid cyst. Different surgical procedures have been suggested, but it is important to select the most appropriate treatment to obtain the best results with the lowest rate of recurrence and minimal morbidity and mortality. The aim of this study was to evaluate the early outcomes of open and laparoscopic surgery of hydatidosis. MATERIALS AND METHODS In this study, 75 patients with uncomplicated liver hydatid cyst were assigned prospectively to either groups of laparoscopic surgery (37, 50.68%) or open procedure (36, 49.32%) during the period of 2007 to 2012. Conversion to open surgery was required in 2 patients (2.67%), who were excluded from the study. Patients were followed for about 17.86±17.64 months. RESULTS Participants included 73 patients: 49 (67.12%) female and 24 (32.88%) male patients, with the mean age of 38.97±16.48 years. There was no statistically significant difference between the 2 groups with regard to the sex, the occupation, and the mean diameter of the cysts. Bilious staining of the cyst content was observed in 23 (35.94%) patients during surgery, and a maximum diameter of 91 mm was considered as a cut point for predicting postoperative fistula with 69.2% sensitivity and 41.1% specificity. The mean duration of operation, postoperative pain, the hospitalization time, and the time to return to work were significantly lower in the laparoscopic group. Postoperative biliary fistula, cyst cavity infection, and wound infection were not different between the 2 groups. CONCLUSIONS Laparoscopic surgery seems to be effective and safe, with low morbidity rates for uncomplicated cysts in accessible segments of the liver.
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The Comparison of 2 New Promising Weapons for the Treatment of Hydatid Cyst Disease: PAIR and Laparoscopic Therapy. Surg Laparosc Endosc Percutan Tech 2016; 25:358-62. [PMID: 26241297 DOI: 10.1097/sle.0000000000000177] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND To compare the effectiveness and safety for hydatid disease treatment, the 2 new minimally invasive therapies: laparoscopic and PAIR (puncture, aspiration, injection, and reaspiration) were compared by systematic meta-analysis. METHODS A comprehensive analysis of published cases from 1990 to 2014 was performed using PubMed database. A total of 231 publications on laparoscopic treatment of hydatid cysts and 298 publications on the PAIR treatment were identified. Thirty-eight studies involved 1230 laparoscope-treated subjects and 41 involved 2686 PAIR-treated subjects in this review. The effectiveness and safety of emphasis is placed on the recurrence, insufficient response, death, cure, and postoperative complications. Operation time and hospital stay are also discussed as new evaluation index. The stages of cyst are summarized to determine which stage is suitable for PAIR. RESULTS Clinical and parasitological cure occurred in 98.7% of patients undergoing laparoscopic intervention and in 97.5% of patients receiving PAIR plus chemotherapy (P<0.014). Recurrence occurred in 1.0% and 1.6%, respectively (P<0.087). Insufficient response occurred in 0.16% and 0.9%, respectively (P<0.009); 2 patients died in each group (P<0.594). Allergic reaction/urticarial/anaphylactic shock occurs in 0.14% and 4.24% of patients receiving laparoscopic intervention and PAIR plus chemotherapy, respectively (P<0.001). Infection/abscess (5.37% and 2.57%; P<0.001) and surgical-related complications (7.32% and 3.43%; P<0.001) were seen more frequently in laparoscopic intervention subjects than PAIR plus chemotherapy subjects. CONCLUSIONS Laparoscopic therapy and PAIR intervention are shown to be safe and effective alternative for open surgery with suitable indication such as cyst type and location. They have different postoperative complication features. The biliary fistula/bile leakage was more frequent in laparoscopic intervention (P<0.001) and fever occurred more in PAIR plus chemotherapy patients.
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Abdelraouf A, El-Aal AAA, Shoeib EY, Attia SS, Hanafy NA, Hassani M, Shoman S. Clinical and serological outcomes with different surgical approaches for human hepatic hydatidosis. Rev Soc Bras Med Trop 2016; 48:587-93. [PMID: 26516969 DOI: 10.1590/0037-8682-0223-2015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/27/2015] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Hydatidosis is the result of infection with the larval stages of some species of the genus Echinococcus. Treatment approaches for hydatid cysts include the use of albendazole, surgery, and/or medico-surgical procedures. The choice of the therapeutic surgical approach depends on the cyst number and localization, surgeon expertise, and presence of complications. The present study aimed to compare the outcomes of the following therapeutic approaches for the treatment of hepatic hydatid cysts: pericystectomy; the puncture, aspiration, injection, and reaspiration (PAIR) technique; and the PAIR technique followed by deroofing, evacuation of cysts, and omentoplasty. METHODS The 54 patients were divided into 3 groups: Group I (14 patients) who underwent pericystectomy, Group II (23 patients) who underwent the PAIR technique, and Group III (17 patients) who underwent the PAIR technique followed by deroofing and omentoplasty. The diagnosis of hydatid cysts was based on serological testing using enzyme-linked immunosorbent assay, abdominal ultrasound, and parasitological examination of the cyst contents. Morbidity, mortality, length of hospital stay, recurrence, and postoperative complications were evaluated. RESULTS Postoperative bleeding, infection, and recurrence were reported in Groups I and II; Group III did not experience postoperative infection and had shorter hospital stays. Recurrence and postoperative complications did not occur in Group III. CONCLUSIONS The partial surgical procedure with deroofing, evacuation of the cysts, and omentoplasty, as performed in the present study, is recommended as a safe and effective method for elimination of the entire parasite with minimal possibility for intra-peritoneal spillage.
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Affiliation(s)
- Amr Abdelraouf
- Department of Surgery, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | | | - Eman Yassin Shoeib
- Department of Medical Parasitology, Faculty of Medicine, Cairo University, Egypt
| | - Samar Sayed Attia
- Department of Medical Parasitology, Faculty of Medicine, Cairo University, Egypt
| | - Nihal Ahmed Hanafy
- Department of Medical Parasitology, Faculty of Medicine, Cairo University, Egypt
| | - Mohamed Hassani
- Department of Tropical Medicine, National Hepatology and Tropical Medicine Research institute, Cairo, Egypt
| | - Soheir Shoman
- Department of Tropical Medicine, National Hepatology and Tropical Medicine Research institute, Cairo, Egypt
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Pakala T, Molina M, Wu GY. Hepatic Echinococcal Cysts: A Review. J Clin Transl Hepatol 2016; 4:39-46. [PMID: 27047771 PMCID: PMC4807142 DOI: 10.14218/jcth.2015.00036] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/15/2015] [Accepted: 12/16/2015] [Indexed: 12/16/2022] Open
Abstract
Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the Echinococcus granulosus tapeworm. E. granulosus are common parasites in certain parts of the world, and are present on every continent with the exception of Antarctica. As a result, a large number of people are affected by CE. The increased emigration of populations from endemic areas where prevalence rates are as high as 5-10% and the relatively quiescent clinical course of CE pose challenges for accurate and timely diagnoses. Upon infection with CE, cyst formation mainly occurs in the liver (70%). Diagnosis involves serum serologic testing for antibodies against hydatid antigens, but preferably with imaging by ultrasound or CT/MRI. Treatment methods include chemotherapy with benzimidazole carbamates and/or surgical approaches, including percutaneous aspiration injection and reaspiration. The success of these methods is influenced by the stage and location of hepatic cysts. However, CE can be clinically silent, and has a high risk for recurrence. It is important to consider the echinococcal parasite in the differential diagnosis of liver cystic lesions, especially in patients of foreign origin, and to perform appropriate long-term follow-ups. The aim of this review is to highlight the epidemiology, natural history, diagnostic methods, and treatment of liver disease caused by E. granulosus.
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Affiliation(s)
- Tina Pakala
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
| | - Marco Molina
- Department of Radiology, University of Connecticut Health Center, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
- Correspondence to: George Y. Wu, Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030, USA. Tel: +1-860-679-2509, Fax: +1-860-679-8582, E-mail:
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Ahumada V, Moraga F, Rada G. Laparoscopy or open surgery for the treatment of hydatid cyst? Medwave 2016; 16 Suppl 1:e6385. [PMID: 27028137 DOI: 10.5867/medwave.2016.6385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The laparoscopic approach has taken a prominent role in the last decades for various surgical conditions, including liver hydatid cyst. However there is controversy about whether it can replace open surgery. Using Epistemonikos database, which is maintained by screening 30 databases, we identified three systematic reviews which together include four relevant studies, all nonrandomized. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded it is unclear whether laparoscopy for hepatic hydatid cyst reduces mortality, morbidity or recurrence compared with open surgery because the certainty of the evidence is very low.
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Affiliation(s)
- Vanessa Ahumada
- Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile. Address: Facultad de Medicina, Pontificia Universidad Católica de Chile, Lira 63, Santiago Centro, Chile.
| | - Felipe Moraga
- Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Gabriel Rada
- Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile; Departamento de Medicina interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Programa de Salud Basada en Evidencia, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; GRADE working group; The Cochrane Collaboration
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Peker KD, Gumusoglu AY, Seyit H, Kabuli HA, Salik AE, Gonenc M, Kapan S, Alis H. Prevention of Postoperative Bile Leak in Partial Cystectomy for Hydatid Liver Disease: Tricks of the Trade. J Gastrointest Surg 2015; 19:2228-34. [PMID: 26438482 DOI: 10.1007/s11605-015-2970-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/24/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The presence of postoperative bile leak is the major outcome measure for the assessment of operative success in partial cystectomy for hydatid liver disease. However, the optimal operative strategy to reduce the postoperative bile leak rate is yet to be defined. METHODS Medical records of patients who underwent partial cystectomy for hydatid liver disease between January 2013 and January 2015 were reviewed in this retrospective analysis. All patients were managed with a specific operative protocol. The primary outcome measure was the rate of persistent postoperative bile leak. The secondary outcome measures were the morbidity and mortality rate, and the length of hospital stay. RESULTS Twenty-eight patients were included in the study. Only one patient (3.6 %) developed persistent postoperative bile leak. The overall morbidity and mortality rate was 17.8 and 0 %, respectively. The median length of hospital stay was 5 days. CONCLUSION Aggressive preventative surgical measures have led to low persistent bile leak rates with low morbidity and mortality.
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Affiliation(s)
- Kivanc Derya Peker
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey.
| | - Alpen Yahya Gumusoglu
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Hakan Seyit
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Hamit Ahmet Kabuli
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Aysun Erbahceci Salik
- Interventional Radiology, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Murat Gonenc
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Selin Kapan
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Halil Alis
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
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