Conservative versus radical surgery for treatment of uncomplicated hepatic hydatid cysts

This work evaluated both radical and conservative surgical approaches in the management of hepatic hydatid cyst. A total of 32 cases with uncomplicated hepatic hydatid cysts were divided into 2 groups according to the type of surgery. Patients in the first group [n=18] were subjected to conservative surgery in the form of endocystectomy, omentoplasty with or without drainage. Cases in the second group [n= 14] underwent radical surgery that included closed pericystectomy, open pericystectomy, wedge hepatic resection or segmentectomy. The results showed that the use of rib cage retractor could avoid the need for thoracotomy incision with its morbidity to manage cysts at the dome of the liver. The mean operating time in GI [140.15 +/- 38.30 mm] was significantly shorter than in GII [190.4 +/- 50.2 mm], with P<0.05. The need of blood transfusion in GI [16.7%] was lesser than in GII [35.7%], but the difference was statistically not significant. The postoperative pain, evaluated by the number of IM analgesic injection was significantly lower in GI [7.2 +/- 3.3] than in GII [9.9 +/- 3.9] with P<0.05. Wound complications were more observed in GII. There was only one reported recurrence in G I in a case with multiorgan cysts that did not receive perioperative anthelmintic chemotherapy. So, conservative surgical management of uncomplicated hepatic hydatid cysts with perioperative anthelmintic chemotherapy supposed to be a simple, safe and effective approach. Its efficacy is comparable to radical surgical procedures with much less morbidity

Pre-operative MRI evaluation of local disease extent in residual / recurrent colorectal and anal cancer

To determine pre-operative MRI accuracy in assessing local disease extent in residual / recurrent colorectal and anal cancer by comparing MRI assessment and staging examination under anaesthesia, Eighteen consecutive patients with recurrent [12 patients] or residual [6 patients] underwent examination under anaesthesia and MRI using a phased array pelvic coil. .Analysis of eight specific anatomical regions for tumor involvement on MRI was performed Findings at examination under anaesthesia and biopsy were recorded. The MRI and examination under anaesthesia findings were correlated with findings at surgery and histopathology. MRI accuracy in determining tumor invasion for all sites assessed were [90%,], sensitivity was [85%,], specificity was [91%], positive predictive value [PPV] was [75%] and negative predictive value [NPV] was [95%]. For those anatomical sites evaluated by both examination under anaesthesia and MRI, MRI was superior to examination under anaesthesia, with an accuracy of 90% Vs 74%. MRI is an accurate technique for assessing disease extent in recurrent / residual colorectal and anal cancer