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Trigui A, Fendri S, Akrout A, Trabelsi J, Daoud R, Saumtally MS, Ketata S, Baklouti S, Boujelbene W, Mzali R, Dziri C, Rejab H, Boujelbene S. Predictive factors of occult cystobiliary fistulas during conservative treatment of hepatic hydatid cyst: a prospective study. J Gastrointest Surg 2024; 28:108-114. [PMID: 38445931 DOI: 10.1016/j.gassur.2023.11.011] [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: 08/05/2023] [Revised: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND Occult cystobiliary fistula (CBF) is a common complication of hepatic hydatid cyst (HHC). It is often the cause of high morbidity of conservative treatment of HHC. This study aimed to determine the predictive factors of occult CBF to establish the indications for the investigation and treatment of these CBFs. METHODS This was a prospective study that included all operated HHCs over a 3-year period. HHCs complicated with large CBFs were not included in the study. Systematic cholecystectomy and methylene blue test for all cysts were performed. RESULTS A total of 46 patients operated on with 113 cysts were included in this study. The median cyst size was 6.7 cm (IQR, 1-38). A total of 114 CBFs were detected in 51 cysts (45.1%). The postoperative course was simple in 95.0% of cases. The specific morbidity rate was 2.7%. In a bivariate study, absence of mass and abdominal pain on palpation, hemoglobin level >11.55 g/dL, negative hydatid serology, cyst size, absence of calcifications, vascular compression, existence of a single cyst, and localization at segment VIII were predictive factors of occult CBF. At the end of the multivariate study, cyst size was determined to be the only predictive factor for occult CBF. A threshold of 3 cm was used. CONCLUSION Cyst size is a major predictive factor for occult CBF.
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Affiliation(s)
- Aymen Trigui
- Department of General and Digestive Surgery, Faculty of Medicine, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia.
| | - Sami Fendri
- Department of General and Digestive Surgery, Faculty of Medicine, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Amira Akrout
- Department of General and Digestive Surgery, Faculty of Medicine, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Jihen Trabelsi
- Department of Epidemiology, Faculty of Medicine, Hedi Cheker Hospital, University of Sfax, Sfax, Tunisia
| | - Rahma Daoud
- Department of General and Digestive Surgery, Faculty of Medicine, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Mohamed Saad Saumtally
- Department of General and Digestive Surgery, Faculty of Medicine, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Salma Ketata
- Department of Anesthesiology, Faculty of Medicine, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Soulaymen Baklouti
- Department of General and Digestive Surgery, Faculty of Medicine, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Wael Boujelbene
- Department of General and Digestive Surgery, Faculty of Medicine, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Rafik Mzali
- Department of General and Digestive Surgery, Faculty of Medicine, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Chadli Dziri
- Department of General Surgery, Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia; Honoris Medical Simulation Center, Tunis, Tunisia
| | - Haithem Rejab
- Department of General and Digestive Surgery, Faculty of Medicine, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Salah Boujelbene
- Department of General and Digestive Surgery, Faculty of Medicine, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
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Denzinger M, Nasir N, Steinkraus K, Michalski C, Hüttner FJ, Traub B. [Treatment concepts for hepatic echinococcosis]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:560-570. [PMID: 36853342 DOI: 10.1007/s00104-023-01825-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The incidence of both cystic (CE) and alveolar echinococcosis (AE) is increasing in Germany. The CE can often be managed with drug treatment and interventional strategies. In contrast, AE shows characteristics of a malignant disease with a high morbidity and mortality. Benzimidazoles are potent drugs for both entities but with the necessity for a lifelong follow-up and the risk of side effects as well as progression under treatment. Therefore, the indications for surgical resection have to be carefully considered; however, the combination of drug treatment and surgery is the only curative approach. Recently, the use of minimally invasive surgery with reduced morbidity and mortality has justified surgical resection for a broader set of patients; however, minimally invasive surgery requires a high level of expertise and optimal perioperative planning. Therefore, treatment strategies, especially for AE require an individual stratified risk-benefit assessment in an interdisciplinary consensus.
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Affiliation(s)
- Maximilian Denzinger
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm, Albert-Einstein Allee 23, Ulm, Deutschland.
| | - Nadir Nasir
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm, Albert-Einstein Allee 23, Ulm, Deutschland
| | - Kira Steinkraus
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm, Albert-Einstein Allee 23, Ulm, Deutschland
| | - Christoph Michalski
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm, Albert-Einstein Allee 23, Ulm, Deutschland
| | - Felix J Hüttner
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm, Albert-Einstein Allee 23, Ulm, Deutschland
| | - Benno Traub
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm, Albert-Einstein Allee 23, Ulm, Deutschland
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Julien C, Le Treut YP, Bourgouin S, Palen A, Hardwigsen J. Closed Cyst Resection for Liver Hydatid Disease: a New Standard. J Gastrointest Surg 2021; 25:436-446. [PMID: 32043223 DOI: 10.1007/s11605-019-04509-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/18/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although radical resections are recommended for the surgical management of liver hydatid disease (LHD), whether closed (CCR) or opened (OCR) cyst resections should be performed remains unclear. The aim of this study was to compare the postoperative and long-term outcomes of CCR and OCR for primary and recurrent LHD. MATERIALS AND METHODS Medical charts of patients who underwent surgery at a single centre were retrospectively reviewed and compared with respect to major postoperative complications and recurrence rates. RESULTS Seventy-nine CCRs and 37 OCRs were included. The major morbidity rates were 19% and 5% in the OCR and CCR groups, respectively (P = 0.036). In multivariate analysis, OCR (P = 0.030, OR = 5.37) and the operative time (P < 0.001, OR = 18.88) were the only independent predictors of major complications. The 5-year and 10-year recurrence rates were both 0% in the CCR group compared to 18% and 27%, respectively, in the OCR group (P < 0.001). The mean time to recurrence was 10.5 (± 8) years. DISCUSSION Closed cyst resection for LHD is a safe and effective approach with a low risk of recurrence. Considering that recurrence could appear more than 10 years after surgery, follow-up of patients should be adapted.
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Affiliation(s)
- Clément 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 Hardwigsen
- Department of Surgery and Liver Transplantation, Hôpital de la Timone, Marseille, France.,Aix Marseille University, 13284, Marseille, France
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Strohäker J, Nadalin S. [Diagnostics and management of intra-abdominal Echinococcus manifestation]. Chirurg 2019; 90:823-832. [PMID: 31312861 DOI: 10.1007/s00104-019-1001-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Cystic and alveolar echinococcosis are two potentially life-threatening diseases caused by the helminthic parasites Echinococcus granulosus or Echinococcus multilocularis, respectively. In central Europe a marked increase in incidence of both forms of echinococcosis has recently been observed. OBJECTIVE There is widespread uncertainty with diagnostic and treatment algorithms due to the close genetic relationship of both parasites and the similar presentation; however, since the treatment and prognosis significantly differ between the two diseases, a correct diagnosis is essential. This review summarizes the similarities and differences in the diagnostics and surgical treatment of these two parasites. RESULTS The correct diagnosis is mainly based on patient history, radiological imaging and serological testing. In cystic echinococcosis cyst viability and stage determine whether treatment is medicinal, interventional, surgical or a watch and wait strategy. For alveolar echinococcosis surgical resection in combination with perioperative or adjuvant medicinal treatment is the gold standard and the only therapeutic option. As identification of the disease is often delayed due to the oligosymptomatic manifestation, complex resections are frequently necessary that need to be treated by a multidisciplinary team of experts. CONCLUSION Echinococcosis is still a neglected disease due to the rarity and thus should be referred to experts in a tertiary hospital to avoid mistreatment or overtreatment. Due to a timely surgical, infectiological and interventional treatment in an interdisciplinary work-up, the prognosis of echinococcosis has significantly improved in recent years.
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Affiliation(s)
- J Strohäker
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
| | - S Nadalin
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland.
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Cirugía de la hidatidosis hepática. Factores de riesgo y variables asociadas al desarrollo de morbilidad postoperatoria. Revisión global de la evidencia existente. Cir Esp 2017; 95:566-576. [DOI: 10.1016/j.ciresp.2017.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/10/2017] [Accepted: 08/19/2017] [Indexed: 12/19/2022]
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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: 258] [Impact Index Per Article: 36.9] [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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Brunetti E, Praticò L, Neumayr A, Maestri M, Tamarozzi F. Update on Treatment for Cystic Echinococcosis of the Liver. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0079-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Lv H, Jiang Y, Liu G, Zhang S, Peng X. Surgical treatment of multiple hydatid cysts in the liver of a pediatric patient. Am J Trop Med Hyg 2015; 92:595-8. [PMID: 25561565 DOI: 10.4269/ajtmh.14-0445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Multiple hydatid cysts in the liver rarely occur in the pediatric population. Here, we present the case of a 16-year-old girl who presented with six hydatid cysts in the liver. The cysts were surgically removed and all found to be infertile. Interestingly, the patient had post-operative eosinophilia. From this experience, we conclude that individualized treatment is necessary for patients with multiple hydatid cysts.
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Affiliation(s)
- Hailong Lv
- Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang Province, China; Department of Histology and Embryology, Medical College, Shihezi University, Shihezi, Xinjiang Province, China
| | - Yufeng Jiang
- Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang Province, China; Department of Histology and Embryology, Medical College, Shihezi University, Shihezi, Xinjiang Province, China
| | - Guisheng Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang Province, China; Department of Histology and Embryology, Medical College, Shihezi University, Shihezi, Xinjiang Province, China
| | - Shijie Zhang
- Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang Province, China; Department of Histology and Embryology, Medical College, Shihezi University, Shihezi, Xinjiang Province, China
| | - Xinyu Peng
- Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang Province, China; Department of Histology and Embryology, Medical College, Shihezi University, Shihezi, Xinjiang Province, China
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Utzinger J, Brattig NW, Leonardo L, Zhou XN, Bergquist R. Progress in research, control and elimination of helminth infections in Asia. Acta Trop 2015; 141:135-45. [PMID: 25446170 DOI: 10.1016/j.actatropica.2014.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Global health has substantially improved over the past 20 years. In low- and middle-income countries, in particular, great strives have been made in the control of communicable diseases, including helminth infections. Nevertheless, the most marginalised communities still suffer from infectious diseases that are intimately connected with poverty and lack of access to essential commodities and services, such as clean water, improved sanitation and sufficient food. A two-pronged approach is thus necessary: (i) intensifying control in remaining high-endemicity areas and pockets of high transmission; and (ii) moving from morbidity control to interruption of disease transmission in low-endemicity areas with the goal of local elimination. The latter will require new tools and strategies, going hand-in-hand with strong partnerships and new strategic alliances. In this special issue of Acta Tropica, 35 articles are featured that, together, provide an up-to-date overview of the latest progress made in research, control and elimination of helminth infections in East and Southeast Asia. The first 12 articles expound tools and approaches for improved detection, surveillance and monitoring of helminth infections. Control and elimination approaches for the most important helminth infections are revisited in the next 20 articles. The three remaining articles are cross-cutting pieces examining the interface of agriculture, environment and helminth infections and providing a rationale for integrated, multi-sectorial control approaches that are necessary for sustaining helminthiasis control and progressively moving towards elimination. An interesting aspect revealed through an in-depth analysis of the provenance of the 35 contributions is that the People's Republic of China emerges as a key player in global health, which is documented through its prominent role in research and control of helminth infection and networking throughout Asia. Policy implications are discussed and will hopefully shape the future agenda for the control and elimination of helminth infections the world over.
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Affiliation(s)
- Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland.
| | - Norbert W Brattig
- Tropical Medicine Section, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, D-20359 Hamburg, Germany
| | - Lydia Leonardo
- College of Public Health, University of the Philippines-Manila, Manila, Philippines
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai 200025, People's Republic of China; Key Laboratory on Biology of Parasite and Vector, Ministry of Health, WHO Collaborating Center for Malaria, Schistosomiasis and Filariasis, Shanghai 200025, People's Republic of China
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