Resultados del tratamiento laparoscópico de los quistes hidatídicos hepáticos no complicados / Results of laparoscopic treatment of uncomplicated hepatic hydatid cysts

Introducción: La cirugía es el tratamiento más efectivo para los pacientes portadores de quistes hidatídicos hepáticos (QHH). Actualmente no existe consenso si la cirugía abierta o laparoscópica es la mejor vía de tratamiento. El objetivo del presente estudio es describir la técnica quirúrgica y los resultados de la cirugía radical (periquistectomía) por vía laparoscópica. Materiales y métodos: Estudio de cohorte no concurrente. Se incluyeron a los pacientes portadores de QHH no complicados en los que se realizó periquistectomía radical laparoscópica entre los años 2007 y 2015 en el Hospital Clínico de la Pontificia Universidad Católica de Chile. Se consignaron variables demográficas, clínicas, características del QHH, morbimortalidad y recurrencia en el seguimiento. Resultados: Se operaron 24 pacientes. La mediana de edad fue de 35 años (3-79). La mediana de tamaño del QHH fue de 8 cm (3-15). Las complicaciones postoperatorias se presentaron en 4 casos (16%); un paciente presentó una fístula biliar (4,1%). No hubo mortalidad en este estudio y la estadía hospitalaria fue de 3 días (2-25). La mediana de seguimiento fue de 57,5 meses (9-106); se observó un caso de recurrencia a nivel hepático que requirió otra cirugía. Conclusiones: El tratamiento radical de los QHH no complicados por vía laparoscópica es factible y seguro; al compararlo con la literatura existente no se aprecian diferencias en la morbimortalidad ni recurrencia.

Introduction: Surgery is the most effective treatment for patients with hepatic hydatid cysts (HHC). Currently there is no consensus whether open or laparoscopic surgery is the best treatment. The aim of this study is to describe the surgical technique and the results of laparoscopic radical surgery (pericystectomy). Material and methods: Non-concurrent cohort study. We included patients with uncomplicated HHC in which it was performed a laparoscopic radical pericystectomy between 2007 and 2015 at the Clinical Hospital of the Pontificia Universidad Catolica de Chile. Demographic and clinical variables, HHC characteristics, morbi-mortality and recurrence at follow-up were recorded. Results: Twenty-four patients were operated. The median age was 35 years (3-79). The median HHC size was 8 centimeters (3-15). Postoperative complications occurred in 4 cases (16%); one patient had a biliary fistula (4.1%). There was no mortality in this study and the hospital stay was 3 days (2-25). Median follow-up was 57.5 months (9-106); a case of hepatic recurrence requiring another surgery was observed. Conclusions: The radical treatment of uncomplicated HHC by laparoscopic surgery is feasible and safe; when compared with existing literature there is no differences in morbi-mortality or recurrence.

Application of ERCP in treatment for biliary complications of hepatic hydatid disease / 中国内镜杂志

Objective To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) in treatment for biliary complications of hepatic hydatid disease. Methods From October 2010 to October 2016 , 27 patients who were admitted for hepatic hydatid disease underwent therapeutic ERCP pre- or post-operation, then we retrospectively analyzed the clinical manifestations, laboratory tests, imaging examinations, ERCP methods and therapeutic effects in perioperative period of ERCP. Results All the 27 patients who underwent ERCP pre-or post-operations because of biliary complications of hepatic hydatid disease obtained good treatment effect. There were some reasons for ERCP, 12 cases for acute suppurative cholangitis and obstructive jaundice caused by intrabiliary rupture and 7 for severe jaundice compress by large hepatic hydatid cyst, whereas 6 cases for biliary fistula and 2 for biliary stricture after operation. 6 indexes including white blood cell count (WBC), aspertate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) were significantly different between 24 hours pre- and 48 hours post- ERCP (P < 0.05), all the patients were improved after operation. Conclusion ERCP which is performed at pre- or post- operation may be an effective treatment for biliary complications of hepatic hydatid disease such as acute suppurative cholangitis, biliary fistula and stricture.

The impact of combined laparoscopic and choledochoscopic treatment on biliary leak in hepatic hydatid disease in a high attitude region / 中华肝胆外科杂志

Objective To explore the impact of combined laparoscopic and choledochoscopic treatment on bile leak in hepatic hydatid disease at a high attitude region.Methods The clinical data of 50 patients who underwent combined laparoscopic and choledochoscopic treatment were compared with 50 patients who underwent laparoscopic surgery alone for hepatic hydatid internal capsule excision surgery.Results In the combined laparoscopic and choledochoscopic group,the incidence of biliary fistula after surgery was 15％,the incision infection rate was 13％,the length of hospitalization was (11.6 ± 3.8) days and the postoperative time to take off drain was (14.3 ± 7.9) days.These were significantly better than those in the laparoscopic alone group.The operation time in the former group was (108.2 ± 28.4)min,which was slightly longer than the laparoscopy group.Conclusion The combined laparoscopic and choledochoscopic treatment is a safer therapeutic option in treating hepatic hydatid disease with less trauma,faster recovery and shorter hospital stay than laparoscopic surgery alone in a high attitude region.