Treatment of Complicated Hepatic Cystic Hydatidosis with Intrabiliary Rupture by Pericystectomy in Combination with Roux-en-Y Hepaticojejunostomy

This study retrospectively reviewed 9 cases of complicated hepatic cystic hydatidosis with intrabiliary rupture who were surgically treated with pericystectomy in combination with Roux-en-Y hepaticojejunostomy in our hospital from 2004 to 2010. The clinical features, results of laboratory tests, B-mode ultrasonography and CT, post-operative recovery, days of hospital stay after the operation and post-operative complications were statistically analyzed and the patients were followed up. The subjects in our series included 7 males and 2 females, whose average age was 50.78±7.58 years. Before operation, 9 patients suffered from pain of the right upper quadrant and jaundice, which, in 4 cases (44.45%), were accompanied with fever and chills. Preoperative B-mode ul-trosonography and CT showed that all the 9 patients had single hydatid cyst, with their diameter being 9.33±1.58 cm on average. The lesions involved segments Ⅴ, Ⅵ in 6 cases, and segment Ⅳ in 3 cases. By WHO classification, 7 cases were classified as CE3 and 2 cases as CE4. They all had choledochectasia. The subjects underwent the surgery uneventfully. Intraoperatively, 2–4 biliary fistula orifices were found, with the average of the orifice being (0.79±0.20) cm. After the operation, one patient developed incision infection, one had pulmonary infection and one suffered from reflux cholangitis. No anastomotic leaks or peri-operative deaths took place and follow-up revealed no recurrence and implantative metastasis. We are led to conclude that pericystectomy in combination with Roux-en-Y hepaticojejunostomy can achieve satisfactory results for the treatment of complicated hepatic cystic hydatidosis with intrabiliary rupture.

Laparoscopic management of hydatid cysts using long ribbon gauze:An initial experience of 37 consecutive cases

Objective:The laparoscopic approach is becoming the standard of care for many surgical disorders.However,in the case of hydatid cysts,laparoscopic management is challenging due to the risk of spillage of hydatid fluid,which can cause an anaphylactic reaction and recurrence.Here,we report our initial experience with laparoscopic partial pericystectomy of hydatid cysts using long ribbon gauze to decrease intra-operative spillage.Method:This was a retrospective study(between January 2010 and December 2021)in the Department of Surgical Gastroenterology,Sanjay Gandhi Postgraduate Institute of Medical Science,a tertiary care referral center in northern India.Here,we have included 37 consecutive patients with hydatid cysts of the liver and spleen.Diagnosis was made by laboratory and imaging findings(abdominal sonography or contrast enhanced CT scans).All patients were managed with laparoscopic partial pericystectomy.Intraoperatively,a betadine-soaked long ribbon gauze,high-pressure suction canula,and an endo-bag were used in all patients.The collected data included patient demography,location,size,and number of cysts,WHO type,operative time,blood loss,postoperative complications,hospital stay and follow-up.Result:In our series,the mean age was 38.4±13.6 years,15(40.5%)were men and 22(59.5%)were women.The right lobe of the liver was the most commonly affected site(21,56.8%).The mean operative time was 80.0±32.0 min,and intraoperative blood loss was 23.6±11.5 mL.Bile leak was present in 6(16.2%)patients.There was no mortality.The hospital stay was 5(3,9)days,and no recurrence was observed at a median follow-up of 36 months.Conclusion:Laparoscopic partial pericystectomy using this technique is safe in the management of hydatid cysts.Simply,proper packing and safe removal of soaked gauzes can minimize the incidence of postoperative complications and recurrence.

Conquering new battlegrounds:Successful management of isolated giant retrovesical hydatid cyst with robotic assistance

Hydatid disease(HD)is an accidental human parasitic infestation by cestodes and is most commonly caused by Echinococcus granulosus.Liver happens to be the most common site of involvement,although involvement of other organ symptoms is not uncommon.Involvement of the retrovesical pouch by hydatidosis is generally secondary in nature with an incidence of 0.1%-0.5%only.Primary retrovesical hydatid cyst(RVHC)is extremely rare with only few cases in existing literature.RVHC can present with a wide gamut of symptoms ranging from asymptomatic to obstructive uropathy.A 38-year-old male presented to us with complaints of lower urinary tract symptoms(LUTS)and was found to have an isolated primary retrovesical hydatid cyst on evaluation.The RVHC had compressed the right ureter leading to a grossly hydronephrotic non-functional right kidney.The patient was started on albendazole therapy and underwent robot assisted right nephroureterectomy and partial pericystectomy for the RVHC.The postoperative period was uneventful with resolution of symptoms.This report highlights the various clinical presentations of RVHC as well as the minimal invasive management of this rare entity.