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Huang L, Zheng B, Li X, Yao J. Association between radical versus conservative surgery and short-term outcomes of hepatic cystic echinococcosis in Nyingchi, China: a retrospective cohort study. BMC Surg 2023; 23:126. [PMID: 37173700 PMCID: PMC10182614 DOI: 10.1186/s12893-023-02000-y] [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: 02/25/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Radical or conservative surgical treatment for hepatic Cystic Echinococcosis (hepatic CE) is controversial. We aimed to measure the association between radical surgery (RS) versus conservative surgery (CS) and short-term outcomes in our cohort. METHODS Medical records of hepatic CE patients' demographic, clinical, radiological, operative and postoperative details who underwent surgical treatment between January 3, 2017 and January 3, 2018 at the Department of General Surgery, Nyingchi People's Hospital, Nyingchi, China, were retrieved and analyzed. The primary outcome was overall morbidity. The secondary outcomes included: (i) bile leakage; (ii) complications of lung, pleura, heart, liver, pancreas and biliary tract; (iii) incision infection and residual cavity abscess formation; (iv) anaphylactic reaction and shock; (v) tear of surrounding tissues; (vi) hospital and post-operative length of stay (LOS); (vii) length of surgery; (viii) blood loss during surgery. Multivariable logistic/linear regression models with various adjustment strategies for confounders were performed to evaluate the association. RESULTS A total of 128 hepatic CE patients were included with 82 (64.1%) and 46 (35.9%) receiving CS and RS, respectively. After fully adjusted, RS was associated with 60% lower risk of overall complication (aOR 0.4; 95%CI, 0.2-0.9) and 0.6-h shorter surgical time (aβ 0.4; 95%CI,-0.0-0.8) comparing to CS. However, RS was associated with more blood loss during surgery (aβ 179.3; 95%CI, 54.2-304.5). CONCLUSION To conclude, RS was associated with a 60% reduction in developing overall complication in the short term, but may result in more blood loss during surgery than CS.
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Affiliation(s)
- Liangping Huang
- Department of Drug and Medical Device Clinical Trial Office, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Hematology and Oncology, Shenzhen Children's Hospital of China Medical University, Shenzhen, China
| | - Benrong Zheng
- Physical Examination Center, Nyingchi People's Hospital, Nyingchi, China
- Department of VIP Health Care Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xi Li
- Department of General Surgery, Nyingchi People's Hospital, Nyingchi, China.
- Department of Thyroid and Breast Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No.600 Tianhe Road, Guangzhou, 510630, China.
| | - Jianchun Yao
- Department of Anesthesiology, Nyingchi People's Hospital, Nyingchi, China.
- Department of Anesthesiology, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Jinping District, Shantou, 515041, Guangdong Province, China.
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Govindasamy A, Bhattarai PR, John J. Liver cystic echinococcosis: a parasitic review. Ther Adv Infect Dis 2023; 10:20499361231171478. [PMID: 37197609 PMCID: PMC10184195 DOI: 10.1177/20499361231171478] [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] [Received: 01/01/2023] [Accepted: 04/05/2023] [Indexed: 05/19/2023] Open
Abstract
Liver cystic echinococcosis (CE), known as hydatid disease, is caused by the tapeworm Echinococcus granulosus sensu lato. Humans are accidental hosts in this zoonotic disease process, and hepatic infection accounts for over two-thirds of all cases. Since signs and symptoms are mainly non-specific, especially in early disease, clinicians should have a low threshold to include CE as a differential diagnosis in patients with positive serology and suggestive radiological findings, especially in endemic regions. The standard management for liver CE depends on the patient's symptoms, the radiological stage, the size and location of the cyst, the presence of complications and the treating clinicians' expertise. In this review, we discuss the lifecycle of Echinococcus granulosus sensu lato and its epidemiology and then focus on discussing the clinical features, diagnosis and treatment options of CE of the liver.
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Affiliation(s)
| | - Pushpa Raj Bhattarai
- Division of General Surgery, Department of Surgery, Frere Hospital and Walter Sisulu University, East London, South Africa
| | - Jeff John
- Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, East London, South Africa
- Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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Ghannouchi M, Rodayna H, Ben Khalifa M, Nacef K, Boudokhan M. Postoperative morbidity risk factors after conservative surgery of hydatic cyst of the liver: a retrospective study of 151 hydatic cysts of the liver. BMC Surg 2022; 22:120. [PMID: 35351087 PMCID: PMC8966364 DOI: 10.1186/s12893-022-01570-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/14/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The purpose of the present paper is to assess the morbidity specifics risk factors of hepatic hydatid cyst after conservative surgery. METHODS We conducted a retrospective study of 102 patients over a period of 13 years, from 2006 to 2019. We included all patients operated on hydatid cyst of the liver, complicated and uncomplicated, in the Department of General Surgery in Tahar Sfar hospital, Mahdia, Tunisia. We excluded patients who received an exclusive medical treatment and those who have other hydatic cyst localizations. RESULTS The cohort was composed of 102 patients with a total of 151 cysts operated on using conservative surgery, among them there was 75 women (73.5%) and 27 men (26.5%). The median age was 43, with extremes ranging from 12 to 88 years. The majority of patients (94.1%) were from rural areas. The cysts were uncomplicated in about half of the cases (48%), elsewhere complications such as compression of neighboring organs (25.5%), opening in the bile ducts (16.7%), infection (9.8%), and rupture in the peritoneum (2%) were found. Conservative surgery was the mainstay of treatment with an overall mortality rate of 1.9%. The overall morbidity rate was 22%: 14% specific morbidity and 8% non-specific morbidity. External biliary fistula was the most common postoperative complication (9%). The predictive factors of morbidity in univariate analysis were: preoperative hydatid cyst infection (P = 0.01), Compressive cysts (P = 0.05), preoperative fever and jaundice, (respectively P = 0.03 and P = 0.02), no one achieved statistical significance in the multivariate model. CONCLUSIONS Preoperative hydatid cyst infection, compressive cysts and preoperative fever and jaundice could be predictor factors of morbidity after conservative surgery for liver hydatid cyst. They must be considered in the treatment and the surgical decision for patients with hydatid cyst.
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Affiliation(s)
- Mossaab Ghannouchi
- Department of General Surgery, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia.
| | - Hawas Rodayna
- Department of General Surgery, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia
| | - Mohamed Ben Khalifa
- Department of General Surgery, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia
| | - Karim Nacef
- Department of General Surgery, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia
| | - Moez Boudokhan
- Department of General Surgery, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia
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Farhat W, Ammar H, Rguez A, Harrabi F, Said MA, Ghabry L, Gupta R, Ben Cheikh A, Ghali H, Ben Rajeb M, Ben Mabrouk M, Ben Ali A. Radical versus conservative surgical treatment of liver hydatid cysts: A paired comparison analysis. Am J Surg 2021; 224:190-195. [PMID: 34949334 DOI: 10.1016/j.amjsurg.2021.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/14/2021] [Accepted: 12/14/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The management of liver hydatid cysts (LHC) is complex and includes surgery, percutaneous drainage, chemotherapy and observation. Broadly, there are two types of surgical treatment for LHC - conservative surgery (CS) and radical surgery (RS). The purpose of this study was to compare the outcome of RS and CS. METHODS Data from all patients with LHC treated in Sahloul Hospital, between January 2000 and December 2019, were retrieved. To minimize selection bias, paired comparison analysis (PCA) was performed. RESULTS A total of 914 patients were included in this study. RS and CS were performed in 284 and 630 patients, respectively. After PCA, 206 patients were included in each group. The incidence of intraoperative bleeding was significantly higher in the RS group. The overall morbidity was significantly lower in the RS group. Thity-four patients developed recurrence with significantly higher recurrence in CS group. CONCLUSION RS is associated with fewer postoperative complications and lower recurrence rate compared to CS. RS may be the preferred procedure for LHC if the expertise is available.
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Affiliation(s)
- Waad Farhat
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Arib Rguez
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Fathia Harrabi
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Mohamed Amine Said
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Linda Ghabry
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India.
| | - Asma Ben Cheikh
- Department of Prevention and Security of Care, Sahloul Hospital, Sousse, Tunisia.
| | - Hela Ghali
- Department of Prevention and Security of Care, Sahloul Hospital, Sousse, Tunisia.
| | - Mohamed Ben Rajeb
- Department of Prevention and Security of Care, Sahloul Hospital, Sousse, Tunisia.
| | | | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia.
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Julien C, Le Treut YP, Bourgouin S, Palen A, Hardwidsen J. Response to Comments on "Closed Cyst Resection for Liver Hydatid Disease: a New Standard". J Gastrointest Surg 2020; 24:2437-2438. [PMID: 32808137 DOI: 10.1007/s11605-020-04775-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/08/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Clement Julien
- Department of Surgery and Liver Transplantation, Hôpital de la Timone, Marseille, France. .,Department of Surgery, Hôpital Sainte Anne, Toulon, France.
| | - Yves Patrice Le Treut
- Department of Surgery and Liver Transplantation, Hôpital de la Timone, Marseille, France.,Aix Marseille University, 13284, Marseille, France
| | | | - Anaïs Palen
- Department of Surgery and Liver Transplantation, Hôpital de la Timone, Marseille, France.,Aix Marseille University, 13284, Marseille, France
| | - Jean Hardwidsen
- Department of Surgery and Liver Transplantation, Hôpital de la Timone, Marseille, France.,Aix Marseille University, 13284, Marseille, France
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Akbulut S, Sahin TT. Comment on Closed Cyst Resection for Liver Hydatid Disease: a New Standard. J Gastrointest Surg 2020; 24:1899-1900. [PMID: 32495140 DOI: 10.1007/s11605-020-04648-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Elazig Yolu 10. Km, 244280, Malatya, Turkey.
| | - Tevfik Tolga Sahin
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Elazig Yolu 10. Km, 244280, Malatya, Turkey
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