The role of laparoscopy in the management of liver hydatid cyst: a single-center experience and world review of the literature

Cystic echinococcosis of the liver in Kazakhstan: The effectiveness of the PAIR method in comparison with laparoscopic and open surgical methods

BACKGROUND

One of the urgent problems of surgical parasitology in the Republic of Kazakhstan is liver cystic echinococcosis. The study aimed to analyze the effectiveness and safety of the percutaneous treatment with different techniques in comparison with the results of laparoscopic and "open" surgical methods.

METHODS

Retrospectively, we analyzed the outcome of 485 patients with active echinococcal cysts in the period from January 2017-July 2023. Indications for surgical treatment and the choice of the intervention method were based on this classification. Patients were conditionally divided into 3 groups: Laparoscopy-33, Laparotomy-319, PAIR-133.

RESULTS

The duration of the operation in the PAIR was significantly shorter compared to the Laparotomy and Laparoscopy groups (55.4vs.225.2 and 215.3, p = 0.0001). There was no intraoperative blood loss in PAIR, whereas in Laparotomy and Laparoscopy there were 146.0 and 111.0. The postoperative stay of patients in PAIR is significantly shorter than in Laparotomy and Laparoscopy (3.8 compared to 7.5 and 6.4, p = 0.0001). The follow-up time averaged 39.8 months ± 21. There were no statistically significant differences in relapses. Laparotomy and PAIR groups had 11 (3.5 %) and 6 (4.5 %) relapses, respectively.

CONCLUSION

In cystic echinococcosis of the liver types CE1, CE3a regardless of the localization, the optimal volume is a PAIR is characterized by a shorter postoperative stay of the patient, early recovery and cure. In the CE2, CE3b stages, laparoscopic pericystectomy is the most effective and safe in individual patients. In case of an intimate arrangement of cysts to tubular structures, the safest method is laparotomy.

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.

Evaluation of the factors influencing the choice of laparoscopic echinococcectomy in liver echinococcosis (LE) and its impact on postoperative outcomes

The aim of this article is to evaluate the factors influencing the choice of laparoscopic echinococcectomy (LapEE) in liver echinococcosis (LE) and its impact on postoperative outcomes. The article presents a retrospective analysis of the effectiveness of LapEE depending on gender, age, cyst location, size and stage of echinococcal cysts (EC) development, also taking into account the performance of drainage or abdominal interventions in relation to the residual cavity (RC). The study included patients with the primary form of LE - 46 patients who underwent LapEE at the State Institution "Republican Specialized Scientific and Practical Medical Center for Surgery, named after the academician V. Vakhidov", between 2019 and 2020. Taking into account the stage of cyst development, various difficulties with aspiration or removal of the cyst contents occurred in only 14 (30.4%) cases, more often with type II-IV cystic echinococcosis (CE). Another problem was the difficulty with adequate revision and treatment of RC (in 6 (13.0%) patients) with predominantly intraparenchymal localization. Difficulties with performing percytectomy with sufficient excision of the fibrous capsule were noted in 9 (19.6%) cases. In the period up to a week after the operation, the drainage was removed for cysts up to 8 cm in 11 (36.7%) cases, with more than 8 cm - in 5 (31.3%). By 3 weeks of observation, the drains were removed in all cases with cysts up to 8 cm, while with large sizes in 12.5% (2 patients) cases, the drainage was removed on days 21-28 and in 1 (6.3%) patient at a later period. In general, in the group, complications from the RC on days 9-27 after LapEE were noted in 10 (21.7%) of 46 patients, fluid accumulation in 8 (17.4%) and suppuration in 2 (4.3%). Most complications were resolved conservatively - 13.0% (in 6 patients), a minimal invasive drainage of the RC was performed in 6.5% (3 patients), 1 (2.2%) patient was operated on with a RC abscess. Among the main factors that technically complicate LapEE, in addition to localization, difficulties with aspiration or removal of cyst contents in CE II, III, and IV are highlighted due to the presence of many daughter cysts that completely fill the maternal membrane (CE II, III) or thick viscous discharge (CE IV), as well as difficulties in performing a pericystectomy for adequate elimination of the RC when the hydatid is located 3/4 or more in the liver parenchyma.

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.

Percutaneous Versus Surgical Interventions for Hepatic Cystic Echinococcosis: A Systematic Review and Meta-Analysis

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.

Laparoscopic radical and conservative surgery for hydatid liver echinococcosis: PSM based comparative analysis of immediate and long-term outcomes

BACKGROUND

The diffusion of laparoscopic radical surgery for hydatid liver echinococcosis remains limited. There are no published data on a comparative analysis of the immediate and long-term results of radical and conservative laparoscopic surgery for liver hydatid cysts. Comparison of the immediate and long-term outcomes after laparoscopic radical and conservative cystectomies was aimed.

METHODS

HPB center (Center 1) and general surgery hospital in an endemic area (Center 2) participated in a retrospective study. Radical surgery included total, subtotal pericystectomy, and liver resection. Conservative surgery comprised cystectomy without/with partial pericystectomy.

RESULTS

The total number of patients who underwent surgery for liver hydatid cysts was 213. Laparoscopic cystectomy was performed in 106 (50%) patients. This number included 47 radical laparoscopic cystectomy (Center 1). Conservative laparoscopic procedures were used in 59 patients (Center 2). Finally, twenty-seven pairs of patients were matched. Immediate outcomes were better for radical treatment in terms of severe morbidity, length of hospital stay, and time of abdominal drainage before and after PSM. The mean follow-up length was 23 (4-66) and 29 (6-66) months and the recurrence rate was 2% and 5% in groups of radical and conservative treatment respectively. No differences were found in 1-, 3-, and 5-year disease free survival. After second PSM for recurrence, 20 pairs were matched with no relapse of disease.

CONCLUSION

Laparoscopic radical surgery leads to the better immediate outcomes and can be recommended as the preferred treatment option in a specialized HPB center. Conservative option is justified in general hospitals in endemic area for selected uncomplicated cysts.

Mid-term Outcomes of Laparoscopic Total Cystectomy Versus Open Surgery for Complicated Liver Hydatid Cysts

Total cystectomy is a challenging procedure in patients with complicated liver hydatid cysts (HCs). This study aimed to evaluate the feasibility and safety of laparoscopic total cystectomy in patients with complicated liver HCs.

A systematic review and meta-analysis on the treatment of liver hydatid cyst using meta-MUMS tool: comparing PAIR and laparoscopic procedures

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.

Long-term results of hepatic hydatid disease managed using palanivelu hydatid system: Indian experience in tertiary center

BACKGROUND

Incidence of hepatic hydatid disease is increasing due to globalization. Surgery is the gold standard treatment. Laparoscopy has gained enough evidence regarding its safety and efficacy. Complete evacuation of hydatid contents without spillage remains a challenge. We aimed to determine long-term results of hepatic hydatid disease managed laparoscopically using palanivelu hydatid system (PHS) at our institution.

METHODS

One hundred and five patients underwent laparoscopic surgical management using the PHS at our institute from May 1997 to May 2013. Clinical presentations, surgical strategy, postoperative morbidity, and long-term recurrence rate were evaluated.

RESULTS

Of the 105 patients, 76 were male and 29 female with a mean age of 32 years (range 14-71 years). The most common presentation was abdominal pain in 61 patients (58%). Sixteen patients had multiple cysts of which nine had involvement of both lobes. Seventy-seven (73.3%) cysts were uncomplicated. Nineteen (18.09%) had a cyst-biliary communication, two were ruptured cysts, and seven were recurrent cysts. All patients underwent successful laparoscopic management where conservative surgery was performed in 94 patients and radical surgery in 11 patients. Post-operative morbidity was seen in 18 (17.14 %) patients, which included deep cavity infection in two cases, post-operative bile leak in 13 cases, and duodenal injury in one case without any mortality. Mean long-term follow-up was 36 months (range 6 months-5 years) with recurrence in two cases.

CONCLUSION

Our long-term results with PHS showed good outcomes in the laparoscopic management of hepatic hydatid disease with conservative surgery as the preferred approach reserving radical surgery only in selected cases.

Conventional versus laparoscopic surgery for hepatic hydatidosis: a 6-year single-center experience

BACKGROUND

The aim of this study is to evaluate the clinical results of laparoscopic surgery compared with conventional surgery.

METHODS

Records of patients who underwent surgery for liver hydatid disease between 2005 and 2011 were reviewed. Operative time, blood loss, conversion to open, postoperative morbidity, mortality, hospital stay, and recurrence rate were measured.

RESULTS

Among 353 eligible patients, 60 were considered for laparoscopic and 293 for conventional surgery. Operative time was slightly increased in laparoscopic group. No major blood loss and blood transfusion were needed. Postoperative hospital stay was significantly short in laparoscopic group (3.8 ± 1.2 days) than that in conventional group (7.4 ± 1.4 days). The overall morbidity was 13.3 % (8/60) in laparoscopic and 19.8 % (58/293) in conventional group without significance. Both conversion rate and mortality was 0 %. One recurrence in laparoscopic (1.7 %, 1/60) and five in conventional group (1.7 %, 5/293) occurred within 48 months of follow-up.

CONCLUSIONS

Laparoscopic treatment of liver hydatid disease is safe and effective in selected patients with all its advantages.

World review of laparoscopic treatment of liver cystic echinococcosis--914 patients

OBJECTIVE

The aim of this study was to provide a review of the world literature on the laparoscopic treatment of liver hydatid cyst.

METHODS

We conducted a literature search using PubMed, screening all English language publications on the laparoscopic treatment of liver hydatid cysts. Operative characteristics, perioperative morbidity, and clinical outcomes were tabulated.

RESULTS

A total of 57 published articles including 914 patients with 1116 hydatid cysts were identified. Of the resections done in the 914 patients, 89.17% were performed totally laparoscopically and 5.58% were gasless. The most common procedure was cystectomy (60.39%), followed by partial pericystectomy (14.77%) and pericystectomy (8.21%); the rest were segmentectomies. Conversion to open laparotomy occurred in 4.92% of reported cases (45/914). The common cause of conversion was anatomical limitations/inaccessible locations (16/45). The overall mortality was 0.22% (2/914 patients) and morbidity was 15.07%, with no intraoperative deaths reported. The most common complication was bile leakage (57/914). The postoperative recurrence was 1.09% (10/914 patients).

CONCLUSIONS

The laparoscopic approach is safe with acceptable mortality and morbidity for both conservative and radical resections in selected patients. Clinical outcomes are comparable to open surgery, albeit in a selected group of patients.