Minimally invasive treatment of hepatic hydatid cysts.

BACKGROUND: Hydatid cyst is a parasitosis caused by Taenia Echinococcus. In the last 10 years, new methods of treatment of the hydatid cyst have been proposed (percutaneous or laparoscopic). METHOD: This retrospective study includes 24 patients with hepatic hydatid cyst (HHC) who were treated by a minimally invasive approach, 18 women and 6 men (average age 49.3 years), representing 10% of all patients with HHC. RESULTS: The average operative time was shortened to about 70 minutes. The conversion rate was 25%. In all cases managed laparoscopically, the prophylactic flooding of the peritoneal cavity was realized with peroxide solution 10 per thousand or with hypertonic saline 30%. The inactivation of the cyst was performed with hypertonic saline in most of the cases. Most cysts were univesicular (62.5%), but there were also multivesicular cysts (37.5%). In two cases patients presented hepatic and pulmonary hydatid disease which were also approached in a minimally invasive manner. The average postoperative period of the cases treated laparoscopically was 6 days and for the converted cases it was 13.3 days. CONCLUSION: The open surgical approach of HHC is highly expensive due to the postoperative period, therefore a laparoscopic approach may be advocated. The minimally invasive method shortens the postoperative hospitalization period, reduces the number of complications as well as the overall costs and facilitates a rapid social reintegration. All these arguments recommend the laparoscopic approach as a standard procedure for hepatic hydatid disease.

Hydatid disease cured by minimally invasive therapy.

Hydatid disease is relatively frequently encountered in general surgery services (4-5% of the total operated cases). The association of the hepatic and pulmonary localizations is quite common, but the involvement of more organs is rare. The asymptomatic rupture of the hydatid cyst in the peritoneal cavity is exceptional. We present the case of a 69-year old female patient who was hospitalized in the 1st Surgical Clinic for irritative dry cough, loss of weight (4 kg in the last 3 months), fatigue, itching and dyspnea. She had been hospitalized in a department of internal medicine for respiratory symptoms when, during X-ray investigation, an opacity was observed, which was suggestive for a pulmonary hydatid cyst. The abdominal ultrasound revealed a multiple hydatid localization (liver, spleen, lower right abdominal quadrant and hypogastrium) and the patient was sent to our clinic. The patient was treated with albendazole 10 mg/kg/day for 10 days before surgery. Surgery was performed by a minimally invasive approach, first by thoracoscopy and, in the same operative session, the other hydatid localizations were approached by laparoscopy. The parasiticide treatment was continued about 3 months after surgery, when the patient was hospitalized again in order to cure the splenic hydatid cyst. Postoperative evolution was complicated by a biliary fistula which resolved spontaneously in 10 days after the intervention. The postoperative hospital stay was 14 days. This case was unusual because of the paucity of symptoms in spite of the multiple abdominal cysts and because it was cured by a modern, minimally invasive approach.