Retroperitoneal laparoscopy for the management of renal hydatid cyst

Prevalence and Molecular Characterization of Cystic Echinococcosis in Livestock Population of the Malakand Division, Khyber Pakhtunkhwa, Pakistan

Cystic echinococcosis (CE) is a neglected zoonotic disease prevalent in Pakistan, but the genetic diversity of the cestode is largely unexplored in the country. This study investigated the molecular epidemiology of CE infecting the livestock population of the Malakand division, Khyber Pakhtunkhwa, Pakistan. A total of 1,200 livestock, including buffaloes, cattle, goats, and sheep, were examined for echinococcosis from November 2017-2018 at different slaughterhouses in the Malakand division. Hydatid cysts were collected from different organs, and hydatid cyst fluid (HCF) was examined microscopically and used for DNA extraction. The LSU (rrnl) and NAD1 genes were amplified and sequenced. The overall prevalence of CE was 17% (204/1,200), including cows (21.7%), buffaloes (17.4%), goats (10%), and sheep (9.6%). The infection was relatively more prevalent among males (17%) than females (16.9%) and animals of older age (>5 years) (p = 0.710). Liver (63.2%) and lungs (25%) were more affected as compared to kidneys (6.8%) and heart (4.9%). HCF analysis indicated that 52.0% of the cysts were sterile and (48.0%) were fertile. Sequencing and phylogenetic analyses confirmed 80.0% of the isolates as Echinococcus granulosus sensu stricto (G1-G3) in all animal species, while Echinococcus equinus (G4) and Echinococcus ortleppi (G5) were present in buffaloes. The present study concluded that CE is prevalent in the livestock population of Malakand. Besides E. granulosus s. s. (G1-G3), E. ortleppi genotype (G5) and E. equinus (G4) in livestock were also reported.

Comparison of Laparoscopic and Open Surgery in the Treatment of Renal Hydatid Cysts

Background: To compare the efficacy, safety, and long-term results of laparoscopic and open approaches in patients undergoing surgery for renal hydatid cyst. Materials and Methods: The files of 36 patients who were surgically treated in our clinic and with diagnosis of renal cyst hydatid confirmed pathologically were reviewed. According to the surgical technique applied, the patients were divided into two groups as open (group 1) or laparoscopic (group 2) partial pericystectomy. Oral albendazole was given 10 mg/kg/day (in two divided doses) for 4 weeks preoperatively and for three cycles of 4 weeks at 1-week intervals after surgery in all patients. Demographic characteristics, laboratory and imaging findings, operation times, hospitalization times, complications, intraoperative bleeding amounts, and recurrence rates were statistically compared in both groups. Results: Open partial pericystectomy was performed in 21 patients in group 1, and laparoscopic transperitoneal partial pericystectomy was performed in 15 patients in group 2. Operation time and intraoperative bleeding amount in group 1 and group 2 were 119.6 ± 17.1/116.1 ± 17.6 minutes and 125.7 ± 27.8/113.9 ± 19.2 mL, respectively. There was no statistically significant difference between these values (P = .557, P = .167, respectively). Hospitalization duration of both groups was 5.9 ± 1.4/3.6 ± 0.7 days, respectively. Hospitalization duration in group 2 was statistically significantly shorter (P < .001). No recurrence occurred during postoperative follow-up in either group. Conclusions: In the treatment of renal hydatid cysts, laparoscopy, which is a minimally invasive approach, can be technically applied with the same principles as open surgery and has a similar efficacy and safety profile for short- and long-term results.

Laparoscopic management of renal hydatid cyst

Introduction:

Renal involvement by hydatid disease is uncommon. The patients may be asymptomatic or present with flank pain, hematuria, and hypertension. Surgery is the mainstay of treatment, and options include cyst deroofing, partial nephrectomy, and total nephrectomy. We share our experience of laparoscopic management of 3 patients with large hydatid cysts of the kidney and review the literature.

Case Description:

Three patients with hydatid cysts of the kidney were treated at our institution between 2008 and 2010. In all 3 patients, hydatid disease involved the left kidney. One of the three cases also had concomitant liver involvement. Abdominal pain was the predominant symptom. A flank mass was palpable in 2 patients. The diagnosis was confirmed on abdominal ultrasonography and computed tomography in all 3 patients. Laparoscopic management was successfully completed in 2 patients. A large intrahepatic cyst in 1 patient prompted conversion to an open procedure. A special hydatid trocar-cannula system helps in eliminating the possibility of spillage from the cyst while puncturing and aspirating the cyst.

Discussion:

There are few reports on laparoscopic management of this uncommon disease of the kidney. In our series the laparoscopic management was attempted in all 3 cases. The procedures included laparoscopic aspiration of the cyst contents along with subtotal excision of the ectocyst in 2 patients and nephrectomy in 1 patient. The latter case had to be converted to an open procedure because of inaccessibility of the intrahepatic liver hydatid cyst. Laparoscopic management of renal hydatid cysts is feasible and safe.

[Not Available]

Objectif :

Étudier le profil épidémiologique ainsi que les caractéristiques cliniques, radiologiques, et thérapeutiques du kyste hydatique du rein (KHR).

Méthodologie :

Quinze cas de KHR colligés de 2004 à 2010 ont été revus. Les données cliniques, radiologiques (arbre urinaire sans préparation, échographie, tomodensitométrie [TDM]) et biologiques (éosinophilie et sérologie hydatique) ont été analysées, et le traitement instauré. L’évolution et les complications ont fait l’objet d’un suivi attentif.

Résultats :

L’âge moyen de découverte du KHR est de 56,13 ans, avec une prédominance masculine (12 hommes, 3 femmes). La symptomatologie clinique est dominée par les lombalgies (60 % des cas). Une analyse de la sérologie hydatique a été demandée pour six patients et s’est révélée positive pour trois d’entre eux. L’abstention thérapeutique a été l’attitude adoptée par deux malades ayant un kyste hydatique de type 5. Aucun patient n’a reçu de traitement médical seul. Treize patients (86,66 %) ont subi une intervention chirurgicale, dont une résection du dôme saillant pour 11 patients, une néphrectomie partielle pour 1 patient et une néphrectomie totale pour 1 autre patient dont le rein était totalement détruit. Aucune complication peropératoire ou postopératoire n’a été signalée, qu’il s’agisse de fistule urinaire ou d’infection de la cavité résiduelle. Aucune récidive n’a été constatée sur une période moyenne de deux ans.

Conclusion :

Le KHR est une pathologie rare sans sémiologie spécifique. Si la chirurgie occupe une place primordiale dans le traitement de ces kystes, de nouvelles perspectives mini-invasives restent à explorer, tout particulièrement les traitements percutané et laparoscopique.

Video-assisted surgery in the management of hydatid renal cyst in children

Renal hydatid disease is rare in children. Open surgery is the traditional method of treatment, but minimally invasive techniques are being increasingly used. Herein, we report our experience with laparoscopic management of renal hydatid cyst in four children via a transperitoneal approach in three cases and a retroperitoneoscopy in one. We conclude that transperitoneal laparoscopy can be offered for the management of hydatid renal cyst associated with other intraperitoneal localizations, whereas the retroperitoneoscopy is limited for the treatment of isolated hydatid renal cysts.

Total laparoscopic management of a large renal hydatid cyst by using hydatid trocar cannula system

Renal hydatidosis usually requires surgical treatment such as pericystectomy, marsupialization, or nephrectomy. In the era of minimally invasive surgery, laparoscopic treatment is preferred. Two main challenges in laparoscopy are to avoid the spillage of contents and to minimize incision for delivering the specimen. We herein discuss the use of a hydatid trocar cannula system (HTCS) to overcome these problems. A 46-year-old male patient having a large renal hydatid cyst (18×15 cm) was operated using HTCS. Three standard laparoscopic ports were placed and the HTCS was placed from the fourth port (18 mm). After aspiration of contents, the cyst was inspected using laparoscope and all contents were sucked. The operation time was 120 min and the total blood loss was around 100 ml. No intraoperative spillage was noted. The patient was orally allowed on Day 2 and discharged on Day 3. Oral albendazole therapy was continued 3 months after the operation. He remained symptom free and abdominal computed tomography did not reveal any recurrences during a follow-up of 2 years. Use of HTCS in renal hydatidosis not only prevents the spillage of hydatid fluid, but also assists in the complete evacuation of contents and allows intracystic visualization to check complete removal of scolices.

Laparoscopic transperitoneal partial nephrectomy for renal hydatid cyst: a case report

A 29-year-old female patient with an isolated hydatid cyst in the lower pole of the left kidney presented with a history of weight loss and cloudy, foul-smelling urine. Laparoscopic partial nephrectomy was performed, at which the cyst was removed en bloc. On the fifth postoperative day, she was discharged without any complication. Nine months postoperatively, a computed tomography scan revealed no recurrence of hydatidosis.

Combined laparoscopic and percutaneous management of calcified renal hydatid cyst--a novel nephroscope- and lithotripter-assisted technique

OBJECTIVE

To describe the novel technique of percutaneous nephroscope-assisted renal hydatid cyst evacuation and lithotripter-assisted division of the cyst wall for combined laparoscopic and percutaneous management.

METHODS

A calcified hydatid cyst of the kidney is a rare entity and needs special techniques for total laparoscopic management. A 45-year-old woman was treated successfully for a calcified renal hydatid cyst using the transperitoneal laparoscopic technique. A chlorhexidine gluconate and cetrimide mixture was used as the scolicidal solution to sterilize the cyst. The endocyst and daughter cysts were removed completely under vision, after placement of a single 26F nephroscope through a 10-mm port in the cyst, with grasper and lithotripter suction, using chlorhexidine-cetrimide mixture irrigation. Laparoscopic suction did not work well for the viscous contents. The calcified cyst wall did not yield to electrocautery or piecemeal fragmentation, until weakened by division and fragmentation using the pneumatic lithotripter. Partial cyst wall exicision/marsupialisation was complemented with omentoplasty.

RESULTS

No intraoperative or early postoperative complications occurred. The patient recovered well with little pain and was discharged early. This technique, in which the principles of percutaneous nephrolithotomy were applied for a special problem, is the first of its type.

CONCLUSION

Calcified renal hydatid cyst evacuation using the novel nephroscope-assisted retrieval of contents and lithotripter-assisted division of the calcified wall is a safe and feasible technique for total minimally invasive management.