Evaluation of the factors influencing the choice of laparoscopic echinococcectomy in liver echinococcosis (LE) and its impact on postoperative outcomes.

The aim of this article is to evaluate the factors influencing the choice of laparoscopic echinococcectomy (LapEE) in liver echinococcosis (LE) and its impact on postoperative outcomes. The article presents a retrospective analysis of the effectiveness of LapEE depending on gender, age, cyst location, size and stage of echinococcal cysts (EC) development, also taking into account the performance of drainage or abdominal interventions in relation to the residual cavity (RC). The study included patients with the primary form of LE - 46 patients who underwent LapEE at the State Institution "Republican Specialized Scientific and Practical Medical Center for Surgery, named after the academician V. Vakhidov", between 2019 and 2020. Taking into account the stage of cyst development, various difficulties with aspiration or removal of the cyst contents occurred in only 14 (30.4%) cases, more often with type II-IV cystic echinococcosis (CE). Another problem was the difficulty with adequate revision and treatment of RC (in 6 (13.0%) patients) with predominantly intraparenchymal localization. Difficulties with performing percytectomy with sufficient excision of the fibrous capsule were noted in 9 (19.6%) cases. In the period up to a week after the operation, the drainage was removed for cysts up to 8 cm in 11 (36.7%) cases, with more than 8 cm - in 5 (31.3%). By 3 weeks of observation, the drains were removed in all cases with cysts up to 8 cm, while with large sizes in 12.5% (2 patients) cases, the drainage was removed on days 21-28 and in 1 (6.3%) patient at a later period. In general, in the group, complications from the RC on days 9-27 after LapEE were noted in 10 (21.7%) of 46 patients, fluid accumulation in 8 (17.4%) and suppuration in 2 (4.3%). Most complications were resolved conservatively - 13.0% (in 6 patients), a minimal invasive drainage of the RC was performed in 6.5% (3 patients), 1 (2.2%) patient was operated on with a RC abscess. Among the main factors that technically complicate LapEE, in addition to localization, difficulties with aspiration or removal of cyst contents in CE II, III, and IV are highlighted due to the presence of many daughter cysts that completely fill the maternal membrane (CE II, III) or thick viscous discharge (CE IV), as well as difficulties in performing a pericystectomy for adequate elimination of the RC when the hydatid is located 3/4 or more in the liver parenchyma.

[Preoperative radiation navigation in determining surgical strategy for liver echinococcosis]. / Predoperatsionnaya luchevaya navigatsiya v opredelenii khirurgicheskoi taktiki pri ekhinokokkoze pecheni.

OBJECTIVE: To analyze the technology for diagnostic modeling of liver echinococcosis. MATERIAL AND METHODS: In the Botkin Clinical Hospital, we developed a theory of diagnostic modeling of liver echinococcosis. Treatment outcomes were analyzed in 264 patients who underwent various surgical interventions. RESULTS: A retrospective group enrolled 147 patients. When comparing the results of diagnostic and surgical stages, we identified 4 models of liver echinococcosis. The choice of surgical intervention in the prospective group was based on previous models. Diagnostic modeling reduced the number of general surgical and specific complications, as well as mortality in the prospective study group. CONCLUSION: The technology for diagnostic modeling of liver echinococcosis made it possible not only to identify 4 models of liver echinococcosis, but also determine the most optimal surgical intervention for each of model.

[Liver echinococcosis in a non-endemic region]. / Ekhinokokkoz pecheni v neendemichnom regione.

OBJECTIVE: To study clinical manifestations and difficulties in diagnosis of liver echinococcosis in a non-endemic region and to assess the long-term results of surgical treatment and quality of life. MATERIAL AND METHODS: The study included 36 residents of a non-endemic region with liver echinococcosis operated on in the Perm Regional Clinical Hospital over the past 15 years. IgG antibodies to echinococcal antigens were determined using enzyme immunoassay. Topical diagnosis was performed using ultrasound and contrast-enhanced computed tomography. We analyzed various difficulties of preoperative diagnosis. Long-term postoperative outcomes and quality of life were studied using the SF-36 questionnaire. RESULTS: In the non-endemic Perm Region, 36% of patients with liver echinococcosis had complicated forms of disease. Sensitivity of detection of antibodies was 77%, ultrasound - 86.1%, CT - 91.7. Echinococcectomy was performed in 13.9% of cases, pericystecomy - 41.7%, liver resection - 30.6%, minimally invasive interventions - in 13.9% of patients. Long-term recurrence of liver echinococcosis (11.1%) developed after laparoscopic echinococcectomy (n=2) and open surgery for multiple liver echinococcosis (n=2). Median score of physical health in long-term period was slightly higher than mental health (67.51 and 62.75 points, respectively). Physical activity had a weak negative correlation with age (p=0.001, r= -0.251). Concomitant diseases significantly impaired vital activity (p=0.001, r= -0.332), role and emotional functioning (p=0.002, r= -0.494; p=0.003, r= -0.415). CONCLUSION: In a non-endemic region, final diagnosis was established only during therapeutic measures in 8.33% of cases. Surgical treatment ensured favorable quality of life in long-term period.

Laparoscopic radical and conservative surgery for hydatid liver echinococcosis: PSM based comparative analysis of immediate and long-term outcomes.

BACKGROUND: The diffusion of laparoscopic radical surgery for hydatid liver echinococcosis remains limited. There are no published data on a comparative analysis of the immediate and long-term results of radical and conservative laparoscopic surgery for liver hydatid cysts. Comparison of the immediate and long-term outcomes after laparoscopic radical and conservative cystectomies was aimed. METHODS: HPB center (Center 1) and general surgery hospital in an endemic area (Center 2) participated in a retrospective study. Radical surgery included total, subtotal pericystectomy, and liver resection. Conservative surgery comprised cystectomy without/with partial pericystectomy. RESULTS: The total number of patients who underwent surgery for liver hydatid cysts was 213. Laparoscopic cystectomy was performed in 106 (50%) patients. This number included 47 radical laparoscopic cystectomy (Center 1). Conservative laparoscopic procedures were used in 59 patients (Center 2). Finally, twenty-seven pairs of patients were matched. Immediate outcomes were better for radical treatment in terms of severe morbidity, length of hospital stay, and time of abdominal drainage before and after PSM. The mean follow-up length was 23 (4-66) and 29 (6-66) months and the recurrence rate was 2% and 5% in groups of radical and conservative treatment respectively. No differences were found in 1-, 3-, and 5-year disease free survival. After second PSM for recurrence, 20 pairs were matched with no relapse of disease. CONCLUSION: Laparoscopic radical surgery leads to the better immediate outcomes and can be recommended as the preferred treatment option in a specialized HPB center. Conservative option is justified in general hospitals in endemic area for selected uncomplicated cysts.

[Echinococcosis of the liver: evolution of surgical treatment]. / Ekhinokokkoz pecheni: evolyutsiya khirurgicheskogo lecheniya.

OBJECTIVE: To analyze the development of surgical approaches for hepatic echinococcosis. MATERIAL AND METHODS: We have analyzed diagnosis and treatment of 349 patients with liver echinococcosis; 97 patients were treated at the Botkin Clinical Hospital for the period from 2009 to 2019 and 252 patients were treated in surgical hospitals of Moscow city for the period from 2014 to 2019. RESULTS: General and specific postoperative complications, relapses and surgical approaches were assessed. The number of echinococcectomies performed in surgical hospitals of Moscow is 3 times higher compared to the Botkin Hospital. The number of liver resections is comparable in both groups. The number of pericystectomies is more than 2 times higher in the Botkin Hospital. PAIR technique was more common in surgical hospitals of Moscow. CONCLUSION: Evolution of surgical treatment from open echinococcectomy to anatomical liver resections and subsequent pericystectomy with PAIR technique becomes another round of evolutionary spiral in the development of surgical treatment of liver echinococcosis.

Epidemiological aspects of echinococcosis of the liver and other organs in the Republic of Uzbekistan.

INTRODUCTION: Recently, in international medical organizations, more and more interest is shown towards diseases in humans, among which the cystic form of echinococcosis (CE) is given special importance. As a zoonotic parasitic disease caused by the larval stage of cestodes belonging to the genus Echinococcus and the Taeniidae family, CE in 2014 was recognized globally by the UN Food and Agriculture Organization (FAO) and WHO as the second most important foodborne parasitic pathology. In the 2018, the European Food Safety Authority (EFSA) considered CE among the food-borne parasites of highest relevance in Europe. PURPOSE: to study the actual epidemiology of human echinococcosis lesion in the Republic of Uzbekistan for 2015-2019 to highlight the mean annual incidence of this pathology in all regions of the country, as well as the extensive value of the proportion of echinococcosis of the liver (EL), lungs (LE) and other localizations. MATERIAL AND METHODS: The officially registered data for all regions of the country for 2015-2019 were studied. An ultrasound screening of the abdominal organs of the population of the Khorezm region was carried out during 2019 to determine the effectiveness of early diagnosis of EL. A total of 104,284 inhabitants were examined, of which 38,660 were children and 65,624 were adults. RESULTS: According to the processed statistical data for all regions of the Republic of Uzbekistan for 2015-2019 on average, 2105.0 ± 43.3 patients with echinococcosis of various localizations were diagnosed. The mean annual incidence was 6.5 ± 0.09 per 100,000 inhabitants. The extensive value of the EL share was 79.4 ± 0.9% (1672.2 ± 35.6 on average per year), high-level rate - 5.2 ± 0.08 per 100,000 inhabitants; the proportion of LE was 14.0 ± 0.8% (295.2 ± 17.8), the prevalence was 0.9 ± 0.06 per 100,000 inhabitants; the proportion of echinococcosis of other localizations was 6.5 ± 0.5% (137.6 ± 13.4), the high-level value was 0.4 ± 0.03 per 100,000 inhabitants. The frequency of detection of the liver or other abdominal organs echinococcosis during screening ultrasound in the Khorezm region was 0.009%, in turn, the examination of family members of these patients increased this indicator to 0.011%.

Liver Echinococcosis complicated with Lesions of Bile Ducts in Azerbaijan.

A total of 302 patients with liver echinococcosis (LE) complicated by lesions of bile duct during 1988 to 2015 were analyzed. The patients were divided into two groups. In the first group, 227 patients were included with lesions of segmental bile ducts in the form of cystobiliary and bilio-bronchial fistulas. In the second group, 75 patients with lesions of hepatic bile were enrolled. Diagnosis of LE and its complications was made by ultrasonography and computed tomography (CT). Surgical treatment included echinococcectomy with complete liquidation of a residual cavity (35.1%), echinococcectomy with suturing (46.0%), external drainage of a residual cavity (7.3%), pericystectomy (8.6%), and resection of a liver (3.0%). Postoperative complications related to operative intervention developed in 29 patients. Lethal outcomes took place in 6 cases (2.0%). The analysis has shown that the form of bile duct lesions, methods of surgical operation for liquidation of hydatid cysts, and its biliary complications had influenced the treatment outcome. More optimal results are received after complete liquidation of residual cavity in different ways and suturing of cystobiliary fistulas during operation. For prevention of complications related to the presence of residual cavity, laser processing of walls of a residual cavity by ozonized 17% hypertonic solution of NaCl was used and this procedure showed obvious (p < 0.05) advantages. HOW TO CITE THIS ARTICLE: Aghayev RM. Liver Echinococcosis complicated with Lesions of Bile Ducts in Azerbaijan. Euroasian J Hepato-Gastroenterol 2016;6(2):125-130.

The curative effect of albendazole combined with cimetidine in the treatment of hepatic echinococcosis / 中国基层医药

Objective To observe the clinical effect of albendazole combined with cimetidine in the treatment of hepatic hydatid disease.Methods 60 cases with liver hydatid disease from 2010 to 2014 wrer selected,and they were randomly divided into two groups,30 cases in each group.The control group was treated with albendazole tablets,2 times daily,2 capsules/time.The treatment group was intravenously injected cimetidine based on the treatment of the control group.Before and after treatment,the ultrasound imaging changes and clinical effect were observed.Results In the control group,the total effective rate was 83.33%(25 /30).In the treatment group, the total effective rate was 96.67%(29 /30).The total effective rate between the two groups had statistically signifi-cant difference(χ2 =9.842,P <0.01).Conclusion Albendazole combined with cimetidine in treatment of hepatic hydatid disease has good curative effect,which can be viewed as first choice in the treatment of hydatid disease.

LAPAROSCOPIC ECHINOCOCCECTOMY IN CHILDREN / Мэс засал

Introduction: In Mongolia laparoscopicsurgery starts 25 years ago, in our center /NCMCH/ we start laparoscopic surgery fromOctober 2013.Materials and metods: The articleanalyzes the results of treatment of 2patients 16 years old girl and 14 yearsold boy, who underwent laparoscopicechinococcectomy. Abdominal ultrasoundshowed solitary echinococcosis in VII liversegment, diameters is 9.8cm and 7.4cm.The echinococcus cysts were removed bylaparoscopy. In residual cavity of echinococcuscyst was performed laparoscopic coagulationof the inner wall of the fibrous capsulewithout drainage. After laparoscopic liverechinococcectomy postoperative period wasmuch more favorable than after traditionalechinococcectomy.Results: to evaluate the therapeutictactics and ways to improve the eliminationof residual cavities after laparoscopicechinococcectomy of liver in children.Conclusions: The hospital stay in thepostoperative period was 3 bed days.Laparoscopic echinococcectomy is goingwithout postoperative complications,without residuals, reduce the duration ofpostoperative hospital stays.

Forty-four years' experience (1963-2006) in the management of primarily infected hydatid cyst of the liver.

BACKGROUND AND AIM: The aim of this study was to report our 44-year experience (1963-2006) in the management of primarily infected hydatid cyst of the liver. This is a retrospective review of demographic data, clinical presentation, diagnostic work-up, surgical management, and long-term outcome of patients treated at our center. MATERIAL AND METHODS: There were 77 patients with operated infected liver cysts. In the same period, a total of 460 cases with liver hydatidosis were treated surgically. Of those with suppurated cysts, 27 were men and 50 were women, with a mean age 54.5 years. RESULTS: Clinical manifestations of an abscess were identified in 75% of the patients. In the earlier cases of the study, the diagnosis was made from the clinical picture, laboratory studies, in combination with plain X-ray, hepatic scintigraphy, and in the later cases with US (ultrasonography), CT (computed tomography) or MRI (magnetic resonance imaging), and ERCP (endoscopic cholangiopangreatography). Abdominal and, rarely, thoracic and abdominal or thoracoabdominal incisions were used. Total cystopericystectomy in 8 patients and partial pericystectomy and proper drainage with one or two drainage tubes of the cystic cavity in the other 69 patients were carried out. Hospital stay was between 13 and 146 days with 5 re-operations. Two patients with grossly suppurated cysts and coexistent medical problems died. The disease recurred in five patients. CONCLUSIONS. We conclude that, under good perioperative antibiotic and metabolic coverage, the infected hydatid cysts have to be completely evacuated and properly drained. The application of "conservative" surgical procedures should be preferred. Further studies are needed to solve the clinical and therapeutic problems of this serious complication.

Focal Hepatic Lesions with Peripheral Eosinophilia: Imaging Features of Various Disease

Due to the recent advent of various imaging modalities such as ultrasonography, computed tomography andmagnetic resonance imaging, as well as knowledge of the characteristic imaging features of hepatic lesions,radiologic examination plays a major role in the differential diagnosis of focal hepatic lesions. However, various'nonspecific' or 'unusual' imaging features of focal hepatic lesions are occasionally encountered, and this makescorrect diagnosis difficult. In such a situation, the presence of peripheral eosinophilia helps narrow the differential diagnoses. The aim of this pictorial essay is to describe the imaging features of various diseaseentities which cause focal hepatic lesions and peripheral eosinophilia.