|
1
|
Regmee S, Maharjan DK, Thapa PB. The Current Protocols in the Management of Hepatic Hydatid Disease. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02724-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
|
2
|
Bayrak M, Altıntas Y. Current approaches in the surgical treatment of liver hydatid disease: single center experience. BMC Surg 2019; 19:95. [PMID: 31315619 PMCID: PMC6637587 DOI: 10.1186/s12893-019-0553-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
Background Liver hydatid disease is a common benign condition in many countries. Compared to open surgery, laparoscopic treatment can play an important role in improving the post-operative recovery, reducing the morbidity and recurrence rate of these patients.The purpose of this study is to show that the laparoscopic method is effective and safe in the treatment of liver hydatid cysts compared to open surgery, even in large cysts. Methods All consecutive cases surgically managed for liver hydatid cyst from 7 January 2008 and 15 January 2010 in our institution were included in this study.The surgical approach (laparoscopic or open) and operative strategy, as well as operative and prognostic outcomes, were analyzed. Cyst size, type, location, presence of biliary tract communication, radiological findings, duration of hospitalization, recurrence and postoperative morbidity were analysed and compared retrospectively. Results A total of 60 patients were included in the study.A total of 23 patients underwent open surgery, and 37 patients underwent laparoscopic surgery.Operation types of laparoscopic surgery were as follows: partial pericystectomy (12patients), total cystectomy(2 patients), partial pericystectomy+total cystectomy(7patients) and cystectomy(16patients).The surgical procedures chosen for open treatment of the residual cavity were partial pericystectomy and omentoplasty(17cases), total pericystectomy(3cases) and partial and total pericystectomy(3cases).Cysto-biliary communication was found in 9 patients. A total of 10 patients underwent preoperative endoscopic retrograde cholangiography, and one patient underwent postoperative endoscopic retrograde cholangiography.There was a progression of hypernatremia in 1 patient, wound infections in 3 patients, and perioperative hemorrhage in 3 patients. There were no statistically significant differences concerning age(p = 0.344), gender(p = 0.318), ASA classification(p = 0.963), Gharbi classification(p = 0.649) whereas there were significant differences related to cyst location(p = 0.040) and size(p = 0.022) in patients undergoing laparoscopic and open surgery. Postoperative temporary biliary fistulas were observed in 2 patients undergoing open surgery. Patients undergoing laparoscopic surgery had the advantages of shorter hospital stays and operation times, less blood loss, faster recovery, and lower wound infection rates. Recurrences were detected in 2.7% of patients undergoing laparoscopic surgery and 4.7% of those undergoing open procedures. Conclusion Compared to open surgery in the treatment of liver hydatid cysts, we have shown that laparoscopic method can be safely performed even in large cysts and/or cysto-biliary communication.
Collapse
Affiliation(s)
- Mehmet Bayrak
- Department of General Surgery , Ozel Ortadogu Hospital, Ziyapasa Mahallesi 67055 Sokak no:1, Adana, Turkey.
| | - Yasemin Altıntas
- Department of Radiology , Ozel Ortadogu Hospital, 01360, Adana, Turkey
| |
Collapse
|
|
3
|
Balen Topić M, Skuhala T, Desnica B, Višković K, Drinković M. Repeated Percutaneous Treatment of Massive Hepatic Cystic Echinococcosis in a Child. Pediatrics 2018; 142:peds.2018-1254. [PMID: 30429271 DOI: 10.1542/peds.2018-1254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Abstract
Because of mostly asymptomatic cyst growth and often-neglected nonspecific low-grade symptoms, many cases of cystic echinococcosis (CE) caused by Echinococcus granulosus in the pediatric population are diagnosed at school age, in an advanced and even complicated stage. In 2003, after 5 months of intermittent dull upper-right abdominal pain and nausea, a 13-year-old boy was diagnosed with massive liver CE, with ∼20 round-shaped double-walled medium-sized infective cysts, which permeated the whole liver. Because of their wide distribution across the liver tissue and the risky superficial position of some cysts, liver transplantation emerged as the optimal therapeutic option. Despite being described as only an exceptionally used method for CE, we subjected our patient on 4 occasions to a radiofrequency energy thermoablation (RFT) procedure similar to the one used for malignant neoplasms. In total, 9 superficially situated cysts were initially treated with RFT by using a 14-gauge outer needle and a temperature of 70°C for 8 minutes per cyst, and the remaining cysts were treated with the puncture-aspiration-instillation-reaspiration procedure, along with albendazole (15 mg/kg per day) therapy, for a period of 20 months. After 2 years of follow-up, 4 residual small-sized semisolidified cysts were seen in the liver, and the patient showed no signs of relapse. Although not routinely used, RFT, along with puncture-aspiration-instillation-reaspiration and prolonged albendazole therapy, has shown good tolerability and long-term efficacy in the treatment of multiple infective CE, which could suggest the usefulness of the RFT method beyond salvage situations in pediatric patients.
Collapse
Affiliation(s)
- Mirjana Balen Topić
- University Hospital for Infectious Diseases Dr Fran Mihaljević, Zagreb, Croatia; .,Department of Infectious Diseases, School of Medicine and
| | - Tomislava Skuhala
- University Hospital for Infectious Diseases Dr Fran Mihaljević, Zagreb, Croatia.,Department of Infectious Diseases, School of Dental Medicine, University of Zagreb, Zagreb, Croatia; and
| | - Boško Desnica
- University Hospital for Infectious Diseases Dr Fran Mihaljević, Zagreb, Croatia
| | - Klaudija Višković
- University Hospital for Infectious Diseases Dr Fran Mihaljević, Zagreb, Croatia
| | | |
Collapse
|
|
4
|
Sevinç B, Karahan Ö, Bakdik S, Aksoy N, Eryilmaz MA. Three complications of Pair (puncture, aspiration, injection, reaspiration) in one case: Recurrent hemobilia, cyst infection and pneumonia. Int J Surg Case Rep 2015; 8C:189-192. [PMID: 25683390 PMCID: PMC4353957 DOI: 10.1016/j.ijscr.2015.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION With the appropriate indications, puncture, aspiration, injection and reaspiration (PAIR) is the most effective minimal invasive method used in the treatment of hydatic cysts. Hemobilia is the hemorrhagia in bile ducts in consequence of any reason. In literature there is no case with hemobilia because of PAIR. This is the first case with recurrent hemobilia, infection in cyst cavity and pneumonia because of PAIR. CASE A 66 years old female patient was admitted to hospital with complaints of abdominal pain, hematemesis and melaena. She gave the history of PAIR for two hydatic cysts. At physical examination, there were jaundice, tenderness at right subcostal area and melaena at rectal digital examination. Hemobilia was detected by abdominal ultrasonography and magnetic resonance cholangiopancreaticography (MRCP). An endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic sphincterotomy were performed. The patient was discharged after 6 days hospital stay. One day after the discharge the patient was admitted to hospital with the same complaints again. Performing ERCP and balloon extraction, the hematoma filling the common bile duct was removed. After the patient was hemodynamically stable for 3 days, she was discharged from the hospital. A week after that the patient was admitted to hospital with the clinical findings of infected hydatic cyst and pneumonia. The patient was treated medically with mechanical ventilation support for 8 days. CONCLUSION It should not be underestimated that, there can be serious complications of PAIR like hemobilia. Therefore, PAIR should be performed only in centers having appropriate medical and surgical facilities.
Collapse
Affiliation(s)
- B Sevinç
- Sarıkaya State Hospital, General Surgery Clinic, Turkey.
| | - Ö Karahan
- Konya University, Meram Medical Faculty, General Surgery Clinic, Turkey
| | - S Bakdik
- Konya Education and Research Hospital, Radiology Department, Turkey
| | - N Aksoy
- Konya Education and Research Hospital, General Surgery Clinic, Turkey
| | - M A Eryilmaz
- Konya Education and Research Hospital, General Surgery Clinic, Turkey
| |
Collapse
|
|
5
|
Gomez i Gavara C, López-Andújar R, Belda Ibáñez T, Ramia Ángel JM, Moya Herraiz &A, Orbis Castellanos F, Pareja Ibars E, San Juan Rodríguez F. Review of the treatment of liver hydatid cysts. World J Gastroenterol 2015; 21:124-131. [PMID: 25574085 PMCID: PMC4284328 DOI: 10.3748/wjg.v21.i1.124] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 09/16/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023] Open
Abstract
A review was carried out in Medline, LILACS and the Cochrane Library. Our database search strategy included the following terms: “hydatid cyst”, “liver”, “management”, “meta-analysis” and “randomized controlled trial”. No language limits were used in the literature search. The latest electronic search date was the 7th of January 2014. Inclusion and exclusion criteria: all relevant studies on the assessment of therapeutic methods for hydatid cysts of the liver were considered for analysis. Information from editorials, letters to publishers, low quality review articles and studies done on animals were excluded from analysis. Additionally, well-structured abstracts from relevant articles were selected and accepted for analysis. Standardized forms were designed for data extraction; two investigators entered the data on patient demographics, methodology, recurrence of HC, mean cyst size and number of cysts per group. Four hundred and fourteen articles were identified using the previously described search strategy. After applying the inclusion and exclusion criteria detailed above, 57 articles were selected for final analysis: one meta-analysis, 9 randomized clinical trials, 5 non-randomized comparative prospective studies, 7 non-comparative prospective studies, and 34 retrospective studies (12 comparative and 22 non-comparative). Our results indicate that antihelminthic treatment alone is not the ideal treatment for liver hydatid cysts. More studies in the literature support the effectiveness of radical treatment compared with conservative treatment. Conservative surgery with omentoplasty is effective in preventing postoperative complications. A laparoscopic approach is safe in some situations. Percutaneous drainage with albendazole therapy is a safe and effective alternative treatment for hydatid cysts of the liver. Radical surgery with pre- and post-operative administration of albendazole is the best treatment option for liver hydatid cysts due to low recurrence and complication rates.
Collapse
|
|
6
|
Is hepatic resection the best treatment for hydatid cyst? J Gastrointest Surg 2012; 16:2086-93. [PMID: 22903365 DOI: 10.1007/s11605-012-1993-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/06/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hydatid disease is a serious public health problem in endemic areas, and the management is controversial. Operative treatment is generally accepted especially in patients presenting complications. Our policy is to perform radical surgery and, whenever possible, anatomic hepatic resection. The purpose is to report our experience and results in the management of liver hydatid disease. METHODS Between January 1991 and December 2010, 97 patients were referred to our department for surgical treatment of hepatic hydatid cyst. Data were retrospectively reviewed. Patients were divided into three treatment groups: conservative surgery (CS), total pericystectomy (PC), and hepatic resection (HR). The main outcome measures were the mortality, morbidity, and recurrence rate. RESULTS Median patient age was 45 years (range, 30-56 years). A total of 105 hydatid cysts were treated. Radical surgery was performed in 85 patients: major HR in 43 patients, minor HR in 9, and total PC in 33. CS was performed in 12 cases. There were no postoperative deaths, and the overall morbidity was 20 %. Postoperative morbidity in the HR group was 20 %. Minor (Grade I/II) and major (Grade III/IV) complications were comparable between groups (p = ns). No statistical difference in duration of hospitalization was observed between the CS and the HR group. One patient in the HR group developed a recurrence. CONCLUSIONS The findings of this study suggest that surgical resection is not associated with much more postoperative and cyst cavity-related complications than the other groups. In addition, there was no mortality and a low recurrence rate.
Collapse
|
|
7
|
|
|
8
|
Abstract
UNLABELLED AIM/MATERIALS AND METHODS: Between January 2000 and June 2007, 3,548 endoscopic retrograde cholangiopancreatography (ERCP) were performed for extrahepatic cholestasis, cholangitis, and choledocholithiasis. The results of ERCPs were evaluated retrospectively and examined carefully to investigate the management and endoscopic therapy of biliary parasites. RESULTS Of the 3,548 patients who underwent ERCP, 24 (0.66%) were found to have biliary parasitosis. The mean age of the biliary parasitosis patients (16 women) was 48.6 (15-77) years. Of these 24 cases, 16 patients had hydatid cystic disease (eight with partial obstruction of the biliary tract, and eight with ruptured cysts), four patients had Fasciola hepatica, and four patients had Ascaris lumbricoides infestation. Endoscopic sphincterotomy was performed, after which the choledochus was examined carefully by balloon catheter and basket procedure. CONCLUSION The ERCP procedure is very useful in the therapy of biliary parasitic infestations.
Collapse
|
|
9
|
Ormeci N, Kir M, Coban S, Emrehan Tüzün A, Ekiz F, Erdem H, Palabiyikoğlu M, Dökmeci A. The usefulness of endoscopic retrograde cholangiopancreatography and (99m)Tc-labeled albumin macroaggregates in diagnosing hydatid disease fistulae. Dig Dis Sci 2007; 52:1410-4. [PMID: 17394074 DOI: 10.1007/s10620-006-9627-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2005] [Accepted: 06/06/2005] [Indexed: 12/28/2022]
Abstract
Hydatid disease is an important health problem in areas where it is endemic. There are several therapeutic modalities, the most important being surgery, antibiotherapy, and percutaneous treatment. In recent years percutaneous treatment has become popular, and for this method or surgery it is sometimes lifesaving to know the relation between the biliary ducts and the cyst cavity. The aim of this study was to examine the usefulness of endoscopic retrograde cholangiopancreatography and (99m)Tc-labeled albumin macroaggregates in diagnosing hydatid disease fistulae before percutaneous or surgical treatment. A total of 72 patients diagnosed with hepatic hydatid disease via ultrasound and serologic tests were enrolled in the study. Endoscopic retrograde cholangiopancreatography was successfully performed in all patients. (99m)Tc-labeled albumin macroaggregates also were injected into cysts at a dose of 1.5-2 mCi just before the treatment. All but three patients were treated percutaneously. Scintigraphy of abdominal and thoracic areas was performed with a GE Starcam 3200 XC/T gamma camera at 30 and 120 min after Tc-labeled albumin macroaggregate injections. Endoscopic retrograde cholangiopancreatography revealed communications between biliary ducts and cyst cavities in nine patients (12.5%). However, (99m)Tc-labeled albumin macroaggregates showed not only leakage into the systemic circulation in nine patients but also into the biliary ducts in two (15.4%). In one patient, mild acute pancreatitis occurred as a complication of endoscopic retrograde cholangiopancreatography. No complications of (99m)Tc-labeled albumin macroaggregates injection were seen. Three patients were surgically treated because of clinically manifested cystobiliary fistulae. We conclude that endoscopic retrograde cholangiopancreatography is a gold standard technique for the diagnosis of communication between the biliary duct and the cyst cavity, and (99m)Tc-labeled albumin macroaggregate injection is useful for revealing leakage into the systemic circulation. The diagnosis of biliary fistulae before percutaneous treatment of hydatid disease may enable planning of the optimal therapy.
Collapse
Affiliation(s)
- Necati Ormeci
- Ankara University Medical School, Department of Gastroenterology, 39 Cd Pembe Köşk Apt 1/4, 06520, Cukurambar Mh, Balgat, Ankara, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
|
10
|
Sakaguchi H, Tanaka T, Marugami N, Kichikawa K, Horiuchi H, Morioka C, Toyohara M, Moriya K, Nishiofuku M, Mitoro A, Fukui H, Hirai T, Yamashita N, Ouji Y, Ishizaka S, Yoshikawa M. Cystic echinococcosis in immigrant from Peru: first case treated with percutaneous treatment in Japan. Parasitol Int 2007; 56:207-10. [PMID: 17382581 DOI: 10.1016/j.parint.2007.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Revised: 02/14/2007] [Accepted: 02/17/2007] [Indexed: 11/25/2022]
Abstract
We report a case of cystic echinococcosis (CE) caused by Echinococcusgranulosus, for which a modified percutaneous evacuation (PEVAC) treatment was applied. The patient had immigrated from Peru to Japan and had 2 hydatid cystic masses, 1 located in segment (S)5 of the liver and the other in S3 (5.3 and 3.5 cm in diameter, respectively), both of which were visualized as pseudotumors by ultrasound (US) examinations. Albendazole treatment showed no effects and surgical treatment was refused. After punctuation of the S5 cyst under US guidance and S3 with CT guidance, 10- and 12-French gauge catheters, respectively, with multiple side holes were inserted. About 60 ml of the cyst contents was drawn out from the S5 lesion and 2 ml from the S3 lesion. Using repetitive manual injections and aspiration of small amounts of hypertonic saline, the remaining cyst content was removed as much as possible, after which 20 and 10 ml of 98% ethanol was injected into the S5 and S3 lesions, respectively. A short-term evaluation during the 4 month-period following the procedure using US revealed nearly complete evacuation of the S5 lesion, whereas that at S3 remained as a pseudo-solid mass. We consider that percutaneous treatment is a safe therapeutic modality for hydatid cysts. This is the first case report of CE treated percutaneously in Japan.
Collapse
Affiliation(s)
- Hiroshi Sakaguchi
- Department of Radiology, Nara Medical University, Kashihara 634-8521, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
11
|
Filippou D, Tselepis D, Filippou G, Papadopoulos V. Advances in liver echinococcosis: diagnosis and treatment. Clin Gastroenterol Hepatol 2007; 5:152-159. [PMID: 17157079 DOI: 10.1016/j.cgh.2006.08.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Echinococcosis or hydatid cyst disease is a zoonosis caused by the larval cestode Echinococcus granulosus. It consists of a parasitic tapeworm disease affecting mainly liver. Nevertheless, the disease might well spread to more unusual sites such as lungs and brain. The definitive diagnosis of liver echinococcosis requires a combination of imaging, serologic, and immunologic studies. Despite the fact that a number of scolecoidal agents have been developed against liver hydatid disease, the cornerstone of the definitive treatment remains surgery. Both the classic surgical techniques and the recently developed minimally invasive and laparoscopic methods target the eradication of the disease by simultaneously avoiding perioperative spillage and dissemination or recurrence of echinococcosis. The present article constitutes a review of the biology of the parasite as well as the epidemiology, diagnosis, and therapeutic options of the liver hydatid disease.
Collapse
Affiliation(s)
- Dimitrios Filippou
- First Department of General Surgery, Piraeus General Hospital Tzaneio, Piraeus, Athens, Greece.
| | | | | | | |
Collapse
|
|
12
|
Kabaalioğlu A, Ceken K, Alimoglu E, Apaydin A. Percutaneous imaging-guided treatment of hydatid liver cysts: Do long-term results make it a first choice? Eur J Radiol 2006; 59:65-73. [PMID: 16513311 DOI: 10.1016/j.ejrad.2006.01.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Revised: 01/18/2006] [Accepted: 01/26/2006] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the long-term results of percutaneous imaging-guided treatment of hydatid liver cysts. MATERIALS AND METHODS Sixty patients with 77 hydatid liver cysts underwent percutaneous treatment with ultrasonography (US) or computed tomography (CT) guidance. Absolute alcohol and hypertonic saline were used for sclerosing the cysts after aspiration. Prophylactic albendazole treatment was given before and after the procedures. Follow-up US and CT were obtained periodically, and changes in cyst morphology were recorded. Minimum follow-up period for the patients included in this study was 12 months. Serological correlation was also available for a group of patients. The outcome of the procedures were categorized into five groups based on morphological changes observed by imaging. RESULTS Procedures were regarded as successful in 80% and unsuccessful in 20% of patients. Failures most often occurred with type III cysts; less than half (39%) of the total type III cysts had a successful outcome. On the other hand, all type I cysts ended up with cure. Anaphylaxis, pneumotorax and severe pain interrupting the procedures were also among the reasons of failure. CONCLUSION Percutaneous aspiration, injection and reaspiration (PAIR) of types I and II hydatid liver cysts is effective and safe in the long-term. Surgery should no longer be regarded as the first choice treatment in all hydatid liver cysts but should be reserved for type III and certain active type IV cysts.
Collapse
Affiliation(s)
- Adnan Kabaalioğlu
- Department of Radiology, Akdeniz University Hospital, Antalya, Turkey.
| | | | | | | |
Collapse
|
|
13
|
Ormeci N, Idilman R, Akyar S, Palabiyikoğlu M, Coban S, Erdem H, Ekiz F. Hydatid cysts in muscle: a modified percutaneous treatment approach. Int J Infect Dis 2006; 11:204-8. [PMID: 16814586 DOI: 10.1016/j.ijid.2005.10.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 09/12/2005] [Accepted: 10/12/2005] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Any organ in the human body may be affected by hydatid disease, but the liver and the lungs are most commonly affected. A rare localization of hydatid disease is within muscle tissue. Herein we present three patients with muscular hydatid disease who were successfully treated with a modified percutaneous approach. METHODS Patients with Gharbi type III cysts were treated on an outpatient basis. All procedures were performed under ultrasound guidance in the ultrasonography unit of our department. After local anesthesia, percutaneous puncture was performed in a one-step procedure. After free drainage stopped, absolute ethanol and polidocanol were injected into the cyst cavity. After the procedure, the patient was observed for at least six hours for any adverse reactions and sent home. Patients were followed-up with ultrasonography. A positive treatment effect was characterized by a reduction of the cyst's pseudo-tumor pattern and size, and by detachment of the germinal membrane. RESULTS The three patients in this report had a total of five hydatid cysts in muscle tissue and were all successfully treated with a modified percutaneous approach without recurrence. CONCLUSION Percutaneous drainage without re-aspiration is simple, easy to apply, low cost, repeatable, and does not require hospitalization. There have been no reported deaths associated with the procedure and morbidity is very low. When the technique is applied properly, relapses do not occur. With its low complication rate and its suitability for outpatient treatment, this method can be an alternative to surgery or puncture, aspiration, injection, and re-aspiration (PAIR) in selected patients.
Collapse
Affiliation(s)
- Necati Ormeci
- Department of Gastroenterology, Ankara University Medical School, Ibn'i Sina Hospital, Sihhiye, Ankara, 06100 Turkey.
| | | | | | | | | | | | | |
Collapse
|
|
14
|
Nasseri Moghaddam S, Abrishami A, Malekzadeh R. Percutaneous needle aspiration, injection, and reaspiration with or without benzimidazole coverage for uncomplicated hepatic hydatid cysts. Cochrane Database Syst Rev 2006:CD003623. [PMID: 16625588 DOI: 10.1002/14651858.cd003623.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hepatic hydatid cyst is an important public health problem in parts of the world where dogs are used for cattle breeding. Management of uncomplicated hepatic hydatid cysts is currently surgical. However, the puncture, aspiration, injection, and re-aspiration (PAIR) method with or without benzimidazole coverage has appeared as an alternative to surgery over the past decade. OBJECTIVES To assess the benefits and harms of PAIR with or without benzimidazole coverage for patients with uncomplicated hepatic hydatid cyst in comparison with sham/no intervention, surgery, or medical treatment. SEARCH STRATEGY The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Controlled Trials Register in The Cochrane Library, MEDLINE, EMBASE, DARE, and ACP Journal Club and full text searches were combined (all searched October 2004). Reference lists of pertinent studies and other identified literature were scanned. Researchers in the field were contacted. SELECTION CRITERIA Only randomised clinical trials using the PAIR method with or without benzimidazole coverage as the experimental treatment of uncomplicated hepatic hydatid cyst (ie, hepatic hydatid cysts which are not infected and do not have any communication with the biliary tree or other viscera) versus no intervention, sham puncture (ie, performing all steps for puncture, pretending that PAIR is being performed, but actually not performing the procedure proper), surgery, or chemotherapy were included. DATA COLLECTION AND ANALYSIS Data were independently extracted and methodological quality of each trial was assessed by the authors. Principal authors of the trials were contacted to retrieve missing data. MAIN RESULTS We found no randomised clinical trials comparing PAIR versus no or sham intervention. We identified only two randomised clinical trials, one comparing PAIR versus surgical treatment (n = 50) and the other comparing PAIR (with or without albendazole) versus albendazole alone (n = 30). Both trials were graded as 'adequate' for allocation concealment; however, generation of allocation sequence and blinding methods were 'unclear' in both of them. Compared to surgery, PAIR plus albendazole obtain similar cyst disappearance and mean cyst diameter with fewer adverse events (32% versus 84%, P < 0.001) and fewer days in hospital (mean + SD) ( 4.2 + 1.5 versus 12.7 + 6.5 days, P < 0.001). Compared to albendazole, PAIR with or without albendazole obtain significantly more often (P < 0.01) cyst reduction and symptomatic relief. AUTHORS' CONCLUSIONS PAIR seems promising, but there is insufficient evidence to support or refute PAIR with or without benzimidazole coverage for treating patients with uncomplicated hepatic hydatid cyst. Further well-designed randomised clinical trials are necessary to address the topic.
Collapse
|
|
15
|
Ormeci N, Idilman R, Tüzün A, Erdem H, Palabiyikoğlu M. A New Percutaneous Approach for the Treatment of Hydatid Cyst of the Kidney: Long-term Follow-up. Int Urol Nephrol 2005; 37:461-4. [PMID: 16307318 DOI: 10.1007/s11255-004-0022-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Renal hydatid disease is an uncommon benign parasitic infestation compared to liver hydatid disease. Although the treatment of hydatid cysts depends on surgery which is related with high morbidity and an overall local recurrence rates, the following case reports describing two patients with renal hydatid cysts were successfully treated with this new percutaneous method.
Collapse
Affiliation(s)
- Necati Ormeci
- Department of Gastroenterology, Ibn-i Sina Hospital, Ankara University School of Medicine, Ankara, Turkey
| | | | | | | | | |
Collapse
|
|
16
|
Schipper HG, Kager PA. Diagnosis and treatment of hepatic echinococcosis: an overview. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 2005:50-5. [PMID: 15696850 DOI: 10.1080/00855920410011004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Surgery has long been considered the first-choice treatment in patients with echinococcosis of the liver. The poorly predictable outcome of older studies using mebendazole or albendazole confirmed this belief. Since the introduction of a percutaneous technique (PAIR; puncture, aspiration, injection, reaspiration) treatment policy is changing. The actual question is which treatment is preferred in which patients. METHODS Review of recent literature. RESULTS Laparoscopic treatment of anteriorly located hepatic cysts is a new surgical technique with high success rates (77%-100%) and low complication (0%-17%) and recurrence rates (0%-9%). Albendazole is superior to mebendazole treatment. Degenerative changes were found in 82% of patients treated with albendazole and in 56% of those treated with mebendazole. The main problem is the high relapse rate: 25% mostly within 2 years. PAIR proved to be superior to albendazole treatment (88% versus 18%) and equally effective as surgery (86% versus 76%). A combined injection of alcohol with polidocanol is a simple alternative to PAIR. Percutaneous evacuation of cyst content (PEVAC) made percutaneous treatment accessible to patients with complicated cysts. CONCLUSIONS Albendazole is the first-choice treatment in patients with univesicular cysts. PAIR or combined injection of alcohol with polidocanol is indicated when pain is intractable or albendazole fails. In patients with multivesicular cysts, PEVAC is a better choice. Surgery is the first-choice treatment only when the expertise of percutaneous treatment is not available or when percutaneous treatment fails.
Collapse
Affiliation(s)
- H G Schipper
- Dept. of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The Netherlands.
| | | |
Collapse
|
|
17
|
Dziri C, Haouet K, Zaouche A, Fingerhut A. Comment traiter un kyste hydatique du foie non compliqué ? ACTA ACUST UNITED AC 2005; 130:249-51. [PMID: 15847860 DOI: 10.1016/j.anchir.2005.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- C Dziri
- Service des urgences, hôpital Charles-Nicolle, boulevard du 9-avril-1938, 1006 Tunis, Tunisie.
| | | | | | | |
Collapse
|
|
18
|
Muftuoglu MAT, Koksal N, Topaloglu U. The role of omentoplasty in the surgical management of remnant cavity in hepatic hydatid cyst. HPB (Oxford) 2005; 7:231-4. [PMID: 18333196 PMCID: PMC2023958 DOI: 10.1080/13651820410022889] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cyst hydatid disease of the liver is still endemic in certain regions of the world. Currently, surgical operation remains the treatment of choice in hydatidosis. The cyst cavity can be managed by using capitonnage, external drainage, introflexion or omentoplasty. METHODS Two hundred and thirty-five patients operated for hydatid cyst between January 1990 and February 2001 were analysed retrospectively. Either omentoplasty, external drainage, capitonnage or introflexion were used to treat residual cyst cavity. RESULTS Patients were categorised into three groups to evaluate complications: omentoplasty alone (group A), omentoplasty combined with other techniques (group B) and other techniques (group C). The overall mortality rates were <1%. Overall morbidity rates were 8.8% for group A, 19% for group B and 25% for group C, respectively. Mean hospital stay was 7.6 days for group A, 11.9 days for group B and 15.8 days for group C. DISCUSSION Postoperative surgical site infection, bile fistula, recurrence rate and overall morbidity were seen less frequently in patients who underwent omentoplasty in our series. Mean duration of hospital stay was significantly shorter in patients who underwent omentoplasty operations. Because omentum has a high absorptive capacity and the capability to fill the residual cavity, we recommend omentoplasty to manage patients with hydatid cyst of the liver, whether complicated or uncomplicated.
Collapse
Affiliation(s)
- M A Tolga Muftuoglu
- Department of General Surgery, Haydarpasa Numune Teaching & Research Hospital, Istanbul, Turkey.
| | | | | |
Collapse
|
|
19
|
Abstract
Treatment of hydatid cyst of the liver ranges from surgical intervention (conventional or laparoscopic approach) to percutaneous drainage and to medical therapy. The aim of this systematic review was to provide "evidence-based" answers to the following questions: Should chemotherapy be used alone or in association with surgery? What is the best surgical technique? When is the percutaneous aspiration injection and reaspiration technique (PAIR) indicated? An extensive electronic search of the relevant literature without limiting it to the English language was carried out using MEDLINE and the Cochrane Library. Key words used for the final search were "hydatid cyst," "liver," "treatment," "meta analysis," "randomized controlled trial," "prospective study," "retrospective study." All relevant studies reporting the assessment of one modality of treatment or a comparison of two or several therapeutic methods to treat hydatid cyst of the liver and published in a peer-reviewed journal were considered for analysis. This systematic review allowed us to conclude that chemotherapy is not the ideal treatment for uncomplicated hydatid cysts of the liver when used alone (level II evidence, grade B recommendation). The level of evidence was too low to help decide between radical or conservative treatment (level IV evidence, grade C recommendation). Omentoplasty associated with radical or conservative treatment is efficient in preventing deep abscesses (level II evidence, grade A recommendation). The laparoscopic approach is safe (level IV evidence, grade C recommendation). Drug treatment associated with surgery (level II evidence, grade C recommendation) requires further studies. Percutaneous drainage associated with albendazole therapy is safe and efficient in selected patients (level II evidence, grade B recommendation). The level of evidence is low concerning treatment of complicated cysts.
Collapse
|
|
20
|
Karaoglanoglu M, Akinci OF, Bozkurt S, Deniz S, Karatas G, Coskun A, Ziylan SZ. Effect of Different Pharmacologic and Chemical Agents on the Integrity of Hydatid Cyst Membranes. AJR Am J Roentgenol 2004; 183:465-9. [PMID: 15269042 DOI: 10.2214/ajr.183.2.1830465] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We performed an in vitro investigation of the effects of widely used scolicidal and sclerosing agents, as well as some pharmacologic products, on the integrity of the membrane of hydatid cysts. MATERIALS AND METHODS Two milliliters each of 22 agents, 2 mL of clear fluid, and one piece of hydatid cyst membrane were put into bottles. The hydatid cyst membranes were evaluated by visual observation and manual palpation. Visual examination of the bottles was performed daily for 7 days, and observations of membrane changes, including translucency, destruction, swelling, and melting, were recorded. Manual evaluation was done on the seventh day by finger examination, and membrane fragility was scored. RESULTS The hydatid cyst membrane was completely melted in a few minutes in a 2.5% solution of sodium hypochlorite and in 1 hr by a 0.1% sodium hypochlorite solution. The integrity of the hydatid cyst membrane was preserved in alcohol, acetone, glutaraldehyde, albendazole, acetylsalicylic acid, formaldehyde, lidocaine, hydrochloric acid, ammonia, pancreatin, Betadine, methylene blue, and isotonic saline samples. The membranes in the metronidazole and hypertonic saline solutions were not damaged but showed significantly increased fragility. The membranes in levamisole and piperazine hexahydrate became translucent and showed moderate fragility. CONCLUSION None of the agents that are used in clinical practice had important effects on the dissolution of hydatid cyst membranes. However, sodium hypochlorite solutions completely melted the hydatid cyst membranes. Because the use of this agent on living tissue is limited, further study is needed to investigate its clinical use.
Collapse
|
|
21
|
Haaga JR, Nakamoto D. Computed Tomography-guided Drainage of Intra-abdominal Infections. Curr Infect Dis Rep 2004; 6:105-114. [PMID: 15023272 DOI: 10.1007/s11908-996-0006-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Image-guided percutaneous abscess drainage has become a standard method of treatment of most abdominal abscesses. In most cases, it should be considered the treatment of choice, but there are selected areas and circumstances that require specific approaches and methods. Typical abscesses within solid parenchyma organs or those in the peritoneal spaces can be reliably detected and efficiently drained. Abscesses that are multiple or long and circuitous require careful placement of catheters. Management of the drainage catheters includes irrigation with fluid to minimize accumulations of material that may impair egress of fluid. In selected cases, fibrinolytic agents have proved effective in shortening the drainage times and shortening hospital stays. Some controversial areas such as splenic abscesses, pancreatic abscesses, echinococcal abscesses, and fungal abscesses should only be attempted with careful selection and meticulous technique. Successful treatment is most likely with candid consultation among the various clinical services.
Collapse
Affiliation(s)
- John R. Haaga
- Diagnostic Radiology, Case Western Reserve University Hospitals, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | | |
Collapse
|
|
22
|
Bastid C, Sahel J. Le traitement percutané des kystes hydatiques est dorénavant une réalité validée par l’OMS. ACTA ACUST UNITED AC 2004. [DOI: 10.1007/bf03008982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|