Comparison of Laparoscopic and Conventional Cystotomy/Partial Cystectomy in Treatment of Liver Hydatidosis

The recurrence rate after primary resection cystic echinococcosis: A meta-analysis and systematic literature review

Cystic echinococcosis (CE) is a chronic, complex, zoonotic disease caused by Echinococcus Granulose tapeworms. The disease may present with a variety of symptoms, ranging from asymptomatic to fatal. Surgical intervention is the primary treatment modality for CE. Despite advances in surgical techniques and chemotherapy, disease recurrence remains a major concern. Therefore, we aimed to determine the true rate of CE recurrence after primary resection and identify possible factors that increase the risk of recurrence. A systematic search of Medline, PubMed, Embase, and Cochran Library was conducted to identify studies reporting the incidence of CE recurrence after primary radical surgery. Data were pooled using random effect models. The disease prevalence was determined by calculating the ratio of CE recurrence and the total number of patients. A meta-regression was conducted to identify any potential factors linked to recurrence. A total of 38 eligible studies, with a total of 6,222 CE patients who underwent primary surgical removal, revealed a pooled recurrence rate of 8% (95% CI: 6%-10%). However, significant heterogeneity was observed (I2 p-value <0.001). Subgroup analysis by region showed the highest incidence of recurrence in European and Turkish studies, with rates of 11% (95% CI: 7%-17%) and 9% (95% CI: 5%-14%), respectively. The lowest recurrence rate was observed in Asian studies, with a rate of 4% (95% CI: 2%-7%). Moreover, the non-radical intervention has a recurrence of 5% (95%CI: 4%-7%), radical 7% (95%CI: 6%-9%), and studies that contained both interventions have 10% (95%CI: 6%-16%), P-value= 0.04. This is the first meta-analysis to evaluate the overall incidence of CE recurrence after primary surgical removal. The study also revealed a substantial degree of heterogeneity across the included studies and indicated possible risk factors for higher recurrence rates, such as the study's geographic area, type of surgery and the year it was published. These findings will help to guide future research in developing effective strategies to prevent or reduce CE recurrence and improve patient outcomes.

Simultaneous Echinococcal superinfection in a patient with polycystic liver disease

Key Clinical Message

Concurrent polycystic liver disease and echinococcus infection can hinder diagnosis. Surgery may be needed for accurate diagnosis and treatment. Multidisciplinary collaboration is crucial.

Abstract

Cystic echinococcosis, caused by Echinococcus granulosus eggs, is a parasitic zoonosis that typically affects humans through accidental ingestion. Polycystic liver disease is a condition characterized by the presence of multiple liver cysts and is often associated with polycystic kidney disease. Here, we present a case of a man in his 70s with a pre-existing diagnosis of polycystic liver disease. Radiological findings of a suspicious cyst in the S4 segment initially lacked serological evidence of echinococcosis; however, intraoperative confirmation revealed the presence of an echinococcal cyst. This article aims to explore both clinical conditions and highlight the therapeutic considerations for their management. Moreover, we discuss the significance of this unique case, emphasizing the possibility of the coexistence of these two pathologies.

Gallbladder Hydatid Disease Complicated with Multiple Hepatobiliopancreatic Fistulae: A Case Report

Gallbladder is a rare localization for hydatid disease. Complications are even rarer and precise diagnosis is quite difficult even with radiological assistance. We report a rare case of 41-yr-old male patient presenting with the rupture of a gallbladder hydatid cyst with multiple fistulae to intra and extrahepatic bile ducts and pancreas, at Kocaeli State Hospital, Turkey in 2021. The patient had abdominal pain and abdominal CT scan reported a bizarre "contrast enhanced cholangiography" sign - radiopaque contrast substance in gallbladder, intra and extrahepatic bile ducts and pancreatic ducts, with concomitant acute cholecystitis. Surgery was performed and intraoperatively gallbladder hydatid cyst with multiple fistulae was noted. Cholecystectomy with total cyst excision was performed. Endoscopic retrograde cholangio pancreatography (ERCP) was utilized to irrigate and eradicate the parasite in the fistulae tracts localized near pancreas and intra/extrahepatic ducts. Postoperative period was uneventful, antiparasitic treatment was started, and in the yearly follow-up patient had no recurrence. Multidisciplinary and minimal invasive management is crucial in such bizarre, complicated cases.

Surgical treatment of liver echinococcosis

This article is based on the treatment results of primary and recurrent epidural infection among 1230 patients treated at three medical institutions: Khorezm Regional Multidisciplinary Medical Center, Clinic of Andijan State Medical Institute, Republican Specialized Scientific and Practical Medical Center for Surgery, between 2015-2020. The comparison group included 621 patients (from 2015 to 2017) who underwent a retrospective analysis. In comparison, the main group of the study included 609 patients (from 2018 to 2020). In the main group of patients, traditional echinococcectomy (EE) was performed in 80.1% of cases, LapEE in 12.3%, and PAIR and PEVAC techniques in 7.6%. The overall incidence of complications from the residual cavity in the comparison group was 36.4% after the PAIR technique, 39.1% after the PEVAC technique, 21.7% after LapEE, and 6.9% (37 out of 503) after traditional and resection EE. The proposed algorithm for selecting a method for treating exocrine pancreatic insufficiency (EPI) made it feasible to optimize tactical approaches to perform traditional and minimally invasive interventions, which ensured a decrease in the incidence of complications from the residual cavity and, accordingly, the need for repeated minimally invasive and open interventions and conservative therapy.

STAGED METHOD OF SURGICAL TREATMENT OF LIVER ECHINOCOCCOSIS

The purpose of the study is to present and evaluate the results of treatment of patients with parasitic liver damage using a modern diagnostic algorithm, various methods and stages of surgical treatment.

Material and methods. The results of treatment of 81 patients (34 men (42%), 47 women (58%)) who underwent 104 surgical interventions for liver echinococcosis in the surgical department No. from 2015 to 2021. The difference in the number of operations performed and actual patients is explained by the use of a staged method of surgical treatment in some cases.

Results. Of the total number of operated patients, one-stage surgical interventions were applied in 64 (79%) cases. In 17 (21%) patients, various staged methods of surgical treatment were applied, which made it possible to exclude some of them from the category of "non-resectable" and perform surgical treatment with good results. An unsatisfactory result of treatment with a fatal outcome was noted in one case from the total array of patients.

Conclusion. The use of a modern diagnostic algorithm, various surgical techniques, including staged minimally invasive and laparoscopic ones, makes it possible to achieve good treatment results in a specialized surgical center.

In vivo and in vitro anti-hydatidosis effect of garlic: a systematic review

Background:

Hydatidosis is a parasitic disease caused by the larval stage of Echinococcus granulosus sensu lato. The aim of the current systematic review study was to clarify the effect of garlic on hydatid cyst in vivo and in vitro.

Method:

We performed our analyses up to Feb 20, 2021, in accordance with the PRISMA guideline. We systematically searched five English databases (Science Direct, PubMed, Scopus, Ovid and Cochrane) and four Persian databases (Scientific Information Database [SID], Iran Medex, Iran Doc, and Magiran) with appropriate syntax. The data was extracted from the relevant articles and analyzed.

Results:

From 160 studies obtained by initial search, nine studies were selected for further analysis. Among 6 in vitro study, 3 (50%) used methanolic extract, 2 (34%) hydroalcoholic and chloroformic extract, and 1 (16%) chloroformic extract. Two (67%) studies used BALB/c mice, and one study (33%) used Swiss albino mice. The method of treatment of mice in all studies was oral. The results showed that garlic has mild to potent effect on hydatidosis and this effect was more considerable in vitro than in vivo.

Conclusion:

Based on the results of various studies, it can be concluded that Allium sativum extract can be used as a suitable alternative to drugs such as Albendazole or can be used as complementary treatment to reduce the dose of the current drugs.

Robotic resection for hydatid disease of the liver

Robotic-assisted surgery for the management of hepatic echinococcosis was introduced in 2016. The advantage it offers over laparoscopy is less rigidity with the use of the 360° rotation of the Endo-Wrist technology, thus allowing the preservation of the integrity of the liver tissue. Herein, we report the first successful robotic resection of the left lobe of the liver for hydatid disease in the Middle East. Our patient is a 71-year-old man found to have a large left hepatic lobe hydatid disease on CT scan. The hydatid liver disease was resected completely with an operation time of 130 min and minimal intraoperative blood loss. Patient did well postoperatively and was discharged home on day 2. Our experience shows that robotic surgery for hydatid disease of the liver can be safely performed, with an excellent outcome to the patient. It also provides unique technical advantages in the field of minimal-invasive surgery.

A review of the diagnosis and management of liver hydatid cyst

Hydatidosis is a zoonosis caused by Echinococcus in the larval stage. Humans are accidental intermediary hosts where cystic lesions develop, primarily in the liver and lungs. It is usually asymptomatic, hence it is usually incidentally identified. Symptoms result from cyst expansion and/or host inflammatory reaction. Hepatomegaly is the most common sign. Hydatidosis induces no specific changes in lab tests, but immunodiagnostics are available that may complement its study, with antibody detection being the method of choice. While ultrasound is the main diagnostic technique, tomography offers more accurate information regarding characteristics and anatomical relations. A number of therapy options are presently available. Treatment with albendazole, whether combined or not with praziquantel, is useful for smaller, uncomplicated cysts (< 5 cm). Only 30 % of cysts disappear with medical treatment alone. Surgery is indicated for bigger liver cysts (> 10 cm), at risk for rupture and/or complicated; the laparoscopic approach is scarcely widespread. The radical technique (total cystopericystectomy) is preferable because o its lower risk for postoperative abdominal infection, biliary fistula, and overall morbidity. Conservative techniques are appropriate in endemic areas where surgery is performed by nonspecialist surgeons. PAIR (puncture-aspiration-injection-reaspiration) is an innovative technique representing an alternative to surgery. It is indicated for inoperable cases and/or patients who reject surgery, for recurrence after surgery, and for lack of response to medical treatment. Active surveillance without treatment may be indicated for quiescent or inactive, uncomplicated liver cysts.

Gallbladder Hydatid Cyst: A Review on Clinical Features, Investigations and Current Management

Background

Gallbladder hydatid cyst (GBHC) is highly uncommon with an incidence of 0.3–0.4% of all atypically located hydatid cysts. Our personal experience of one case of primary GBHC (PGBHC) managed laparoscopically motivated this systematic review. This study aimed to analyze the demographic characteristics, types [whether primary GBHC (PGBHC) or secondary GBHC (SGBHC)], clinical presentation, laboratory investigations, imaging studies, operative procedure, hospital stay, follow-up and recurrence.

Methods

A systematic review was performed using preferred reporting items for systematic reviews and meta-analyses guidelines.

Results

Twenty studies, including 22 cases plus one more case managed by us, were included in the review. For PGBHC, the mean age was 48.61 years while for SGBHC it was 47.9 years. PGBHC was more common in females (69.23%) while SGBHC was more common in males (55.55%). Overall, GBHC was more common in females (56.52%). The most common presentation overall was abdominal pain (100%) followed by nausea/vomiting (43.47%). The other common symptoms were nausea/vomiting (61.53%) and Murphy’s sign (38.46%) in PGBHC, but jaundice (50%) and fever (30%) in SGBHC. In PGBHC, 50% patients had normal liver function while this was deranged in 66.66% patients with SGBHC. Serology was positive in 50% of PGBHC and 100% in SGBHC. Ultrasonography was positive in 50%, while CT-scan showed 70%. CT-scan was better at detection of SGBHC (100%). The most common operation was open cholecystectomy (78.26%) either isolated or combined. Isolated open cholecystectomy was commonly done in PGBHC (69.23%). Overall, only 56.52% of patients received albendazole, but no recurrence was reported. The average hospital stay was 7.25 days and follow-up ranged from 1 month to 10 years.

Conclusion

GBHC mostly affects females with abdominal pain being the most common symptom. Ultrasonography is expedient though CT-scan is more sensitive. Albendazole monotherapy has questionable value. Open cholecystectomy is the most common operation. However, laparoscopy is safe in experienced hands.

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