Cystopericystectomy for treatment of hydatid disease of the liver: a prospective randomized study

Surgical intervention remains the principal form of definitive treatment of liver echinococcosis. The aim of this report is to evaluate the technique of cystopericystectomy for treatment of liver hydatid disease, comparing the results of this technique with the traditional surgical technique of cyst evacuation. Method: Twenty three patients with hydatid disease of the liver were randomized into two groups. Twelve cases were managed by cystopericystectomy and compared with 11 cases managed by the more conservative technique of cyst evacuation. Thoracic x-ray, abdominal ultrasound and computed tomography had been performed previously. The following aspects were considered as selection criteria: Cyst located in segments III, IV, V, VI and VIII; and no evidence of infection or calcification. Cystopericystecomy was total closed cystopericystectomy [n=6], total open cystopericystectomy[n=4], and subtotal cystopericystectomy[n=2]. All patients were treated with oral albemdazole for two months after surgery. The mean operation time, blood transfusion, hospital stay and any evidence of hydatid recurrence we measured and statistical analysis was done. Result: Surgery was performed on 23 patients with liver hydatid disease [12 women and 11 men] with a mean age of 44.9 years [range, 22-83 years], the mean diameter of liver cyst was 7.6 cm [range, 5-12 cm]. The mean [s.d] operration time was 186.3 +/- 35.2 minutes in the group of cystopericystectomy, and it was 145.4 +/- 24.6 minutes in the traditional surgical technique of cyst evacuation, and the difference was statistically significant [P<0.05]. Blood transfusion was required in 5 patients [41.6%] in the group of cystopericystectomy, and in 2 patients [18.2%] in the traditional technique of cyst evacuation, and the difference was not statistically significant [P>0.05]. Hospital stay was 11.3 +/- 4.1 days in cystopericystectomy group and 12.1 +/- 4.6 days in the traditional techique of cyst evacuation, with no difference between the two groups. During a mean follow - up period of 18 months [range, 12-30 months], no mortality was verified. The incidence of postoperative complications was 8.3% in the group randomized to cystopericystectomy and it was 18.2% in the group randomized to cyst evacuatin. Recurrence of hydatid disease was observed in one patient [9.1%] in the group treated by cyst evacuation, but no recurrence was observed in cystopericystectomy. The technique of cystopericystectomy is a valuable alternative to the more conservative technique of cyst evacuation in selective cases. The results of cystopericystectomy are comparable with the results of conservative surgical technique, with a lower incidence of morbidity and recurrence of hydatid disease in cystopericystectomy when compared with the traditional more conservative surgical technique of cyst evacuation

Endorectal flap advancement repair versus seton fistulotomy for high anal fistuala

In this study, the clinical results of endorectal flap advancement were assessed and compared with the results of the traditional seton fistulotomy technique for treatment of high transsphincteric and suprasphincteric anal fistulas, trying to search for a definite role of endorectal flap advancement in the management of high transsphincteric and suprasphincteric anal fistulas. A total of twenty three patients with high transsphincteric [n= 19] and suprasphincteric [n=4] fistulas were randomized into endorectal advancement flap repair [11 patients] or two-stage seton fistulotomy [12 patients] in a prospective study during the period from September 1996 to May 2001 at Ain-Shams University Hospitals. Clinical outcome was assessed in terms of continence and recurrence during a follow-up for three months after operation. Successful healing was achieved in 10 patients of the group randomized to endorectal advancement flap repair and in 10 patients of the group randomized to two-stage seton fistulotomy. Recurrent fistula occurred in one patient of the endorectal advancement flap group and in 2 patients of the seton group. Continence disturbance in the form of lack of control of gas was noted in one patient of the first group and in 2 patients of the other group

Y-V or pedicle flapanoplasty for anal stricture and mucosal ectropion

This prospective study compared the results of Y-V anoplasty with the results of advancement diamond-shaped pedicle flap techinque for repair of post-surgical and stricture or ectropion of the anal mucosa. The study included 20 patients who had anal stenosis [n=12] or diamond-shaped pedicle flap anoplasty. Concurrent lateral internal sphincterotomy was also employed in selected patients who had a fibrotic muscular component contributing to the stenosis. It was found that both Y-V and pedicle flap anoplasty are useful techniques for treatment of post-surgical and stricture and mucosal ectropion with satisfactory results. The pedicle advancement skin flap technique was found to be slightly superior with less postoperative complications, although the difference was not statistically significant [P >0.05 chi square test]. In conclusion, the current preference for anal strictures refractory to dilatation or mucosal ectropion is a diamond pedicle advancement flap