A systematic review and meta-analysis on the treatment of liver hydatid cyst: Comparing laparoscopic and open surgeries

Giant Calcified Hepatic Hydatid Cyst: A Case Report

Hydatid disease is a zoonotic disease caused by the parasite Echinococcus granulosus. It is an endemic disease in many parts of the world. Although humans are incidental hosts of the parasite, the disease sometimes results in fatal consequences. The liver and lungs are the most common sites of infection in humans. We report the case of a 45-year-old female who presented with complaints of right hypochondriac pain, fever, and cough, initially suspected as a case of liver abscess but later diagnosed as a giant calcified hydatid cyst of the liver. Imaging and immunoglobulin G for Echinococcus granulosus helped confirm our diagnosis. Based on her symptoms, the patient was treated symptomatically with analgesics, paracetamol, and an antitussive for pain, fever, and cough, respectively. In terms of definitive care, she was treated with oral albendazole and referred to her home district for necessary surgical intervention.

Laparoscopic Management of Abdominal Echinococcosis: A Technical Report on Surgical Techniques and Outcomes

This technical report explores the efficacy and methodology of laparoscopic surgery for treating abdominal echinococcosis, a parasitic infection caused by Echinococcus granulosus. We highlight the zoonotic nature of the disease, which predominantly affects the liver and occasionally other organs, noting the challenge of its asymptomatic progression that complicates timely diagnosis and intervention. We detail our surgical technique using a standard laparoscopy kit to address abdominal hydatid cysts, emphasizing the critical importance of preventing cyst rupture and spillage to avoid recurrence and anaphylactic shock. We discuss considerations for opting for laparoscopy over open surgery, such as reduced postoperative morbidity, faster patient recovery, and lower costs, while also acknowledging limitations like restricted instrument movement and the absence of haptic feedback. We advocate hypertonic saline as the preferred scolicidal agent and strategies to minimize spillage and manage the residual cavity. In conclusion, we assert that laparoscopy offers a viable and effective treatment option for abdominal echinococcosis, emphasizing that optimizing outcomes for this benign condition hinges on careful patient selection and a conservative surgical approach.

[Laparoscopic excision versus open excision for the treatment of choledochal cysts: a systematic review and meta-analysis]

OBJECTIVE

To determine if laparoscopic excision is more effective than open excision in the treatment of choledochal cysts.

MATERIAL AND METHODS

A systematic review of randomized clinical trials in 3 databases measuring the efficacy of laparoscopic and open excision of choledochal cysts was performed. The authors considered international and national reports, whose results were analyzed in detail.

RESULTS

Mean duration of laparoscopic excision was 51 min, open excision - 35.4 min. Length of hospital-stay after laparoscopic excision ranged between 5 and 74 days, after open excision - between 7 and 146 days. Bile leakage rate was 1-2% and 4%, respectively. Laparoscopic excision was followed by lower complication rate. Morbidity and mortality in laparoscopic excision was 20% and 0%, in open excision - 60% and 3.3%, respectively.

CONCLUSION

Laparoscopic excision is more effective than open excision in the treatment of choledochal cysts.

Extrapleural Intrathoracic Hydatid Cyst: A Rare Cause of Upper Limb Neuropathic Pain

Human echinococcosis is a common zoonotic disease. Due to favourable climatic conditions, India contributes to the majority of the burden of cystic echinococcosis (CE) in the world. The lung is the most commonly affected organ in the body, after the liver. Common symptoms of pulmonary hydatid cyst (PHC) include cough, chest pain, expectoration, and hemoptysis. This case report is a rare presentation of hydatid disease of the thoracic cavity with complaints of upper limb neuropathic pain. Radiological investigation showed an extrapleural thoracic cyst compressing the brachial plexus, and serological findings confirmed the diagnosis of a hydatid cyst. The patient was taken up for cyst excision as it is the treatment of choice along with adjuvant chemotherapy.

A meta-analysis of systematic reviews and meta-analyses to evaluate the psychological consequences of COVID-19

BACKGROUND

Several meta-analysis studies have been reported in the literature on the incidence of psychopathological conditions resulting from the COVID-19 pandemic. This investigation aims to compile and analyze the findings of previously published meta-analysis research, as shown by the present meta-analysis of previous meta-analysis studies.

METHODS

The PubMed and Scopus databases were searched from 1 January 2019 to 30 May 2022. The procedure was carried out according to the PRISMA flow chart and the qualities of the identified studies were analyzed using AMSTAR 2. Heterogeneities and risk of bias were assessed using the Meta-MUMS tool. The corresponding results, forest and funnel plots of the psychological consequences of COVID-19 were synthesized.

RESULTS

Eleven meta-analysis studies were included. Random-effects meta-analysis of anxiety and depression showed (ER = 0.318 p-value < 0.001, ER = 0.295 p-value < 0.001) high heterogeneities (I2 = 99.70%, I2 = 99.75) between studies. Random-effects meta-analyses of sleep difficulties and insomnia were shown (ER = 0.347 p-value < 0.001, ER = 0.265, p-value < 0.001) along with heterogeneities (I2 = 99.89, I2 = 99.64). According to the random meta-analysis of post-traumatic stress syndrome (PTSS) and post-traumatic stress disorder (PTSD) (ER = 0.246, p-value = 0.001, ER = 0.223 p-value < 0.001) with heterogeneities (I2 = 99.75, I2 = 99.17). Random-effects meta-analyses of somatic and fear symptoms have been shown (ER = 0.16 p-value < 0.001, ER = 0.41, p-value = 0.089) with high heterogeneities (I2 = 99.62, I2 = 98.63). Random-effects meta-analysis of obsessive-compulsive symptoms and distress (ER = 0.297 p-value = 0.103; ER = 0.428, p-value = 0.013) with high heterogeneity, as I2 = 99.38%. Subgroup analysis of all symptoms and Egger's tests for detecting publication bias were also assessed.

CONCLUSION

The data from the current meta-analysis showed different psychological disorders of COVID-19 during the pandemic. Clinicians should be aware of the prevalence with which COVID-19-infected patients experience emotional distress, anxiety, fatigue, and PTSD. About half of the included systematic reviews (SRs)/meta-analyses (MAs) suffered from poorer methodological quality and increased risk of bias, reducing confidence in the findings. There must be more SRs/MAs and high-quality clinical trials conducted to confirm these findings.

Management of liver hydatid cyst: A case report

Hydatid disease, if not properly managed, can lead to mortality. Open surgery is preferred and can be a curative approach for multiple and large liver hydatid cysts. Also, regular follow-up is required to detect recurrence.

Management of Liver Hydatid Cysts: A Retrospective Analysis of 293 Surgical Cases from Southern Iran

Background

The current study aimed to evaluate the therapeutic features and complications of liver hydatid cyst in patients who underwent surgery for cystic echinococcosis (CE) in Fars province, southern Iran.

Methods

A total of 293 patients who underwent surgery for liver hydatid cyst from 2004 to 2018 in Fars province, southern Iran, were retrospectively evaluated. The clinical records of patients were reviewed, and the demographic and clinical characteristics of each patient were assessed.

Results

Of the total of 293 cases, 178 (60.9%) were females and 115 (39.1%) were males. The mean age of the subjects was 37.22 (±20.55) years. The mean size of the liver hydatid cyst was 9.18 (±4.365) cm. Of the 293 patients studied, 227 (77.4%) had hydatid cysts only in the liver, while 55 (9.4%) had both liver and lung cysts. More than half of the liver cysts (65.9%) were located in the right portion of the liver (segment 5 to 8). Of the 293 cases, 52 (17.7%) underwent radical surgery, while 241 (82.3%) underwent conservative surgery. Recurrence of hydatid cyst was recorded in 46 (15%) of cases. Patients who were treated with radical surgery in comparison with those who had conservative surgery had a lower recurrence rate but a longer duration of hospital stay (P < 0.05).

Conclusion

Recurrence remains as one of the major challenges in the management of hydatid cyst. Radical surgery reduces the chance of recurrence, although this procedure increases the length of hospital stay.

Turkish HPB Surgery Association consensus report on hepatic cystic Echinococcosis (HCE)

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.

Laparoscopic Treatment Strategies for Liver Echinococcosis

Liver echinococcosis is clinically mainly composed of hepatic cystic echinococcosis (CE) and hepatic alveolar echinococcosis (AE). At present, laparoscopy has been comprehensively applied in the treatment of two types of liver echinococcosis. For hepatic CE treatment, both laparoscopic total pericystectomy and laparoscopic hepatectomy can achieve radical results, but the former is considered the first choice owing to its being more minimally invasive; laparoscopic subtotal pericystectomy and laparoscopic partial pericystectomy can be accepted as complementary options, considering the presence of complicated cysts and the level of laparoscopic technique in remote hospitals; laparoscopic cystectomy is simple, but it is not currently recommended for treatment of hepatic CE owing to poor efficacy and high risk of postoperative complications. For hepatic AE treatment, laparoscopy not only achieves the same radical effect as open surgery in selected patients, but also is more minimally invasive, so it has a better prospect.

Primary intraosseous mandibular hydatid cyst: A case report and review of 97 cases of osseous cystic echinococcosis

OBJECTIVE

In this study, we review the reported cases of hydatid disease of the bone in terms of etiology, pathogenesis, and histopathologic, serologic, and radiographic features and management of the disease.

STUDY DESIGN

The present case study reports an extremely rare occurrence of intraosseous hydatid cysts in the orofacial region, wherein symptoms or signs of systemic hydatid disease were absent. We discuss the challenges encountered during the diagnosis and treatment of osseous hydatidosis and reviewed articles on osseous hydatidosis, including 97 cases. We also compare the aspects reported in previous cases of mandibular hydatid cyst with those of the present case.

RESULTS

Hydatid cysts were found to be present in almost every bone of the skeleton in patients (mean age of 39.95 ± 19.67 years; range, 3-76 years). A slight male preference (58.8%) was observed. A history of rural lifestyle, animal bites, and trauma in the affected bone was reported. Only 5 reports on mandibular bone have been published previously, of which 3 were primary.

CONCLUSION

Because of the lack of usual presentations and radiographic features, the presence of hydatid cysts in unusual anatomic locations makes differential diagnosis difficult. The potential risk of anaphylactic shock in susceptible individuals, high recurrence rate, and risk of secondary hydatidosis pose diagnostic and surgical challenges.

A rare case of concurrent pulmonary and hepatic hydatid cysts treated by single-stage surgical management

A 37-year-old woman was diagnosed with concurrent pulmonary and hepatic hydatid cysts. We performed simultaneous resection of hydatid cysts in the liver and right lung using a single-stage surgical procedure. The patient completely recovered.

Hydatid Disease of the Liver in the Middle East: A Single Center Experience

Background: Human cystic echinococcosis (CE), most commonly caused by echinococcosis granulosis, is the most common presentation of hydatid disease of the liver and is considered endemic in the Middle East region. Patients and Methods: This study is a retrospective single-center analysis of all patients with hepatic hydatid disease presenting for surgical management from 2001 to 2019. Results: From 2001 to 2019, 100 patients (54 males, 46 females) were diagnosed with hydatid disease of the liver with a mean age of 45 years (range, 19-82). The most common presenting symptom was right upper quadrant abdominal pain followed by incidental finding of cyst on imaging. Thirteen patients (13%) presented with signs and symptoms of obstructive jaundice. Of the 100 patients, 39 underwent laparoscopic surgery and 61 underwent open surgery. The most common complications were as follows: 16 bile leaks (16%), 14 intra-abdominal fluid collections (14%), 8 wound infections (8%), and 3 patients had biliary strictures (3%). Of the 100, 8 patients(8%) had recurrence of their hepatic hydatid disease. Conclusions: Hydatid disease of the liver is not a common disease, and its management can include medical, surgical, and interventional radiology. The decision depends on the size and complexity of the cyst and its location. Bile leak is a common complication and should be managed conservatively or through intervention by radiology or endoscopic retrograde cholangiopancreatography (ERCP).

Risk factors for major complications after liver resection: A large liver resection study from Morocco and audit of a non-Eastern/non-Western experience

BACKGROUND AND STUDY AIMS

In developing countries, endemic indications, blood shortages, and the scarcity of liver surgeons and intensive care providers can affect liver resection (LR) outcomes, but these have been rarely addressed in the literature. Therefore, in this study we determined risk factors for major complications after LR in a North African general surgery and teaching department.

PATIENTS AND METHODS

From January 2010 to December 2015, 213 consecutive LRs were performed on 203 patients. All patients underwent a postoperative follow-up of >90 days. Postoperative complications were assessed according to the Clavien-Dindo (CD) classification of surgical complications. A score of CD ≥III is considered as major postoperative complications. In this study, we analyzed the variables assumed to affect these complications.

RESULTS

The overall 90-day complication rate was 35.7% (n = 76), including a CD ≥III of 14% (n = 30) and a mortality rate of 6.1% (n = 14). According to the multivariate analysis, a preoperative performance status (PS) of ≥2 (P = 0.011; odds ratios [OR], 6.8; 95% confidence intervals [CI], 1.55-29.8), an estimated intraoperative blood loss of >500 ml (P = 0.002; OR, 3.71; 95% CI, 1.23-11.20), and bilioenteric anastomosis (P < 0.004; OR, 7.76; 95% CI, 1.5-3.89) were independent risk factors for major complications after LR.

CONCLUSION

We recommend that, in the setting of a non-Eastern/non-Western general surgery and teaching department, patients with a PS of ≥2 should undergo a specific selection and preoperative optimization protocol; intermittent clamping indications should be extended; and special attention should paid to patients undergoing LR associated with biliary reconstruction, such as for perihilar cholangiocarcinoma.

Uncommon Locations of Cystic Echinococcosis: A Report of 46 Cases from Southern Iran

Background

Most cases of hydatid cysts form in the liver and lung and other tissues are considered as unusual locations in hydatid cysts. The current study aimed to find out the rate and features of hydatid cysts in uncommon locations in Fars Province, Southern Iran, over a 15-year period.

Methods

The hospital records of patients who underwent surgery for hydatid cysts in university-affiliated hospitals in Fars Province, Southern Iran, from 2004 to 2018, were retrospectively reviewed. For each patient, clinical and demographical data were recorded.

Results

During a 15-year period, a total of 501 patients were surgically treated for hydatid cysts, and out of these, 46 (9.2%) were presented with the unusual locations of hydatid disease. Males constituted 28 (60.9%) of these patients while 18 (39.1%) of the patients were females. The patients' age ranged from 5 to 80 years (mean = 40.49; SD = 20.37). The size of the cysts ranged from 2 to 20 cm (mean = 8.69, SD = 4.59). The most common unusual location for the hydatid cyst was the spleen with 30.4% of cases, followed by the pelvic cavity (15.2%). Out of 46 cases with unusual location of the hydatid cyst, 10 (21.7%) cases had lung, 22 (47.8%) cases had liver, and 5 (10.9%) cases had both liver and lung hydatid cysts, simultaneously with cysts in unusual locations.

Conclusion

In cystic echinococcosis- (CE) endemic areas, hydatid disease can affect any organ, from head to toe, in humans. The disease should be considered in the differential diagnosis of any cystic entities anywhere in the body.

Successful Management of a Huge Pulmonary Hydatid Cyst with Lung-Preserving Surgery

The lung is the second most commonly involved organ in humans by hydatid disease. Management of large pulmonary hydatid cysts is a great challenge for thoracic surgeons. Lung resections should be considered the last choice for huge pulmonary hydatid cysts when the lung expansion is not optimal after cyst removal. Here, we present a case of huge lung hydatid cyst involving the entire right lower lobe which was successfully managed by lung-preserving surgery in which the postoperative course showed gradual resolution of the involved lobe during a one-year follow-up.

Analysis of Early and Distant Results of Various Options for Eliminating the Residual Liver Cavity Following Echinococcectomy

Introduction. The available literature on the surgery of echinococcosis is mainly presented by retrospective studies, and the results of these studies are often contradictory, especially when it comes to options for the elimination of the residual cavity after removal of the parasitic liver cyst. In this regard, the main purpose of this work is to evaluate the effectiveness of various ways to eliminate the residual liver cavity after echinococcectomy.Materials and methods. The Republican clinical hospital was the host (city of Ufa, Russia) to conduct a prospective analysis of 234 cases of laparotomic surgical removal of echinococcal cysts in the period from 2000 to 2017. The patients were divided into three groups depending on the surgical tactics to solve the problem of residual liver cavity: the first group (n = 84) patients underwent capitonnage and intussusception of the fibrous capsule of the residual cavity; in the second (n = 79) group the greater omental pedicle flap was tamponaded; in the third (n = 71) group underwent the maximum possible excision of the fibrous capsule and the remaining empty space in the liver was opened into the abdominal cavity.Results and discussion: The suppuration of the residual cavity, being the most frequent complication encountered in our study, with almost the same frequency was noted in both groups of patients, where the elimination of the residual cavity was carried out by capitonnage or greater omentum tamponading. According to multifactorial analysis, infectious complications and recurrence of echinococcus were statistically lower in group III than in other groups (p = 0.002 and 0.001; p = 0.004 and p = 0.002).Conclusion. The findings showed that the safest option for “frugal” echinococcectomy was the maximum possible excision of the fibrous cap with subsequent aplatisation. This approach was characterised by the least number of infectious complications and did not require repeated interventions.