A 15-year experience (1988-2003) in the management of liver hydatidosis in northwestern Greece.

Hydatid disease (HD) is a parasitic infection often caused by the larvae of Echinococcus granulosus and rarely by Echinococcus multilocularis in endemic areas. This study aims to emphasize the perioperative administration of anthelmintic therapy over the different surgical procedures aimed at curing HD, because radical resection remains the only potentially curative treatment for hepatic echinococcosis. From October 1988 to September 2003, a total of 140 patients with echinococcal disease were studied: 125 presented with liver HD and 15 with extrahepatic echinococcus cysts (79 men and 62 women; median age, 47.8 years). Right hypochondriac pain, hepatomegaly, and dyspeptic complaints were the major symptoms, whereas cholestatic jaundice and itching were observed in 37 patients (28%). Ultrasound scan and computed tomography scan were performed in all patients preoperatively. The initial diagnosis was confirmed in all cases postoperatively by histological and anatomo-pathological examinations. All patients were given albendazole preoperatively for 5-7 days (10 mg/kg), continued for 4-6 weeks postoperatively in case where the protoscoleces were viable. The majority of the patients presented with one solitary cyst (68%), whereas 45 of the remaining (32%) presented with multiple cysts (two to four). The mean diameter of the cyst was 7 cm. One hundred thirty patients (93%) presented for regular follow-ups, and the median follow-up period was 52 months (range, 23-78 months). In conclusion, surgical treatment is indicated for liver HD because the rate for a definitive cure of the disease is high, and complications and recurrence risk is low. Albendazole treatment should preferably be administered perioperatively and always after R1 resection.

Ultrasonically activated shears in extended lymphadenectomy for gastric cancer.

Gastrectomy, followed by extended lymphadenectomy, is the treatment of choice in some stages of advanced gastric cancer. Lymphorrhea, as a result of the many divided lymphatic vessels, increases the morbidity. Ultrasonically activated coagulated shears (UACS) may divide all small vessels followed by immediate sealing of the coapted vessel walls. We designed a prospective randomized study to determine the effectiveness of the UACS versus monopolar electrosurgery in D2 dissection. Forty patients with gastric cancer stage II or stage IIIA were enrolled and randomized into 2 groups of 20 patients each. Group A underwent lymphatic dissection with monopolar cautery. Group B underwent lymphatic dissection with UACS. Subhepatic and left sudiaphragmatic closed drains were left until lymphorrhea and/or oozing stopped. Total gastrectomy was performed in 16 patients of group A and 14 of group B; subtotal gastrectomy was performed in 4 patients in group A and 6 patients in group B. The drains were removed after 6-17 days (mean 9.7 +/- 2.9) in group Aand after 4-8 days (mean 5.6 +/- 1.2) in group B(p < 0.001). The total amount of drained fluid was 300-2050 ml (mean 985 +/- 602) in group A and 230-1080 ml (mean 480 +/- 242) in group B (p < 0.002). Eight patients in group A and 5 in group B had postoperative fever, while 3 and 1 patients, respectively, had wound infections. In conclusion the use of UACS is a safe method of lymphatic dissection which reduces operative blood loss, postoperative lymphorrhea, blood transfusions,and hospital stay.