Surgical management of hydatid liver cysts; inra-operative pair, cysto-pericystectomy and omentoplasty

ABSTRACT

Liver hydatid cysts caused by Echinococcus granulosus presents medical, veterinary and economic problems worldwide. In an attempt to eradicate liver hydatid cysts by eliminating the parasite, disappearance of the residual cavity, preventing complications and recurrence, the present study was done in Theodore Bilharz Research Institute on 36 patients. They were 11 females and 25 males with age ranging between 18-55 years old. All patients were sub to a full history taking and clinical examination, a full battery of hematological, biochemical, immunological and radiological investigations. Intra-operative Puncture Aspiration Injection and Re-aspiration [PAIR] was performed to all cysts before surgical intervention. Total cysto-pericystectomy [CPC] was done in 25 patients with both open and closed technique. Partial cysto-pericystectomy was done in 11 patients due to firm adherence of the cyst to the liver structures. Omentoplasty [OP] was performed to fill all cavities accompanied with external open system drainage tube. There were no mortalities in this study. Post operative complications were found in 7 patients. Cystectomy and omentoplasty related complication were found in 3 patients, General surgical complications were found in 1 patient. Biliary related complications occurred in 3 patients in the form of biliary leak in 2 patients and biliary fistulae in 1 patients. All these complications responded well to conservative management. A combination of different radical and conservative surgical modalities in the same sitting in the form of intra-operative Puncture Aspiration Injection and Re-aspiration, cystopericystectomy and omentoplasty could be considered the surgical method of choice with no mortality