[Laparoscopic treatment of hydatid liver cysts]. / Tratamiento laparoscópico de los quistes hidatidicos hepáticos.

In the treatment of the liver hydatid cyst, many surgical techniques have been used, from aspiration, drainage, marsupialization to the complete excision of the cyst with segmentary liver resection. With the appearance of laparoscopic surgery, new chances for the treatment of liver hydatidoses come to us in this frequent pathology in our country. In this paper we show the laparoscopic technique used in some patients seen by us in the last years. After we made the diagnosis, we gave medical treatment with albendazol 400 mg per day during 90 days, prior to surgery. We also used antibiotic prophylaxis with wide spectrum antibiotics. Surgery was performed with the patient in dorsal decubitus with ports: umbilical; 10 mm for angled optics (30-45 ), epigastric;10 mm, for right subcostal in the mid collar bone position. 5 mm for aspiration and forceps and right subcostal and front axillar line. We performed a diagnostic laparoscopy to visualize the cyst. We introduced soaked gauzes with ClNa 21% surrounding the cyst specially in the more protruded zone. Afterwards we punctured the cyst and took laboratory samples searching for the scolex in the direct exam, then we injected ClNa 21% in the cyst. It stay for 5 minutes and we made rechanges for 4-5 times. We take a piece of the wall cyst and adventicy for pathological examination. We take out the germinative layer and the daughter s hydatides with care to put them in extraction bags to leave out their content in a ClNa 21% recipient. Finally we retrieved the gauzes previously introduced, we suck the remaining fluid and introduce a piece of epiplon inside the residual cavity, fixed with suture points to the border and left a 16F fenestrated probe that is left outside by a lateral port. The postoperative management is the same as the laparoscopic colecystectomy. The oral route begins when the postoperative ileum is over (12 to 24 hours), treatment of the pain, prompt deambulation and discharge in relation of the external drainage (on average after 48 to 72 hours).