Hepatic hydatid disease: laparoscopic versus percutaneous treatment

ABSTRACT

Selection of the most appropriate treatment to obtain the best results with the lowest rate of recurrence and minimal morbidity and mortality is mandatory for the management of hepatic hydatid disease. The surgical approach is the mainstay of treatment, and there has been a tendency toward laparoscopic surgery [LS], and more recently, percutaneous treatment [PT], which has become increasingly popular with revolutions in techniques. The aim of this study was to evaluate the results of the laparoscopic treatment and PT combined with medical treatment in noncomplicated hydatid cyst in the liver with regard to the technique, postoperative morbidity, safety, effectiveness, and recurrence during the 18-month follow-up period. During the study period September 2005-October 2009, a total of 50 patients diagnosed with uncomplicated hydatid cyst in the liver were prospectively assigned to either LS [n=15] or PT [n=35]; albendazole was given at a dose of 10 mg/kg twice per day starting 1 week and continuing for 4 weeks after the procedure. Patients were followed for any complication, hospital stay, or recurrence. Moreover, compliance for medical treatment and appearance of any side effect related to the drug were noted during the follow-up period. Fifteen patients underwent LS and 35 patients underwent PT. There was no statistically significant difference between both groups as regards age, sex, or mean diameter of the cysts. There was only one patient with biliary fistula after LS, whereas biliary fistula occurred in two patients after the PT procedure. Postoperative infection and abscess in the cyst cavity occurred in one patient in the laparoscopic group and in three patients in the PT group. The mean hospital stay for the LS group was significantly longer than the PT group [7.3 days vs. 1 day, respectively], P value was less than 0.001. During the follow-up period, local recurrence was seen in one patient [6.7%] in the LS group and in twp patients [5.7%] in the PT group. LS seems to be effective and safe with low morbidity and recurrence rates in uncomplicated hydatid cysts of the liver in accessible locations, but the procedure has its own disadvantages, such as limited area of surgical manipulation. PT combined with oral albendazole should be the method of choice, being safe, effective, and inexpensive, especially in the treatment of types 1, 2, and some type 3 cysts in patients who are contraindicated for surgery or general anesthesia and who do not accept surgery