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Laparoscopic Treatment Strategies for Liver Echinococcosis. Infect Dis Ther 2022; 11:1415-1426. [PMID: 35751754 PMCID: PMC9334471 DOI: 10.1007/s40121-022-00664-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
Liver echinococcosis is clinically mainly composed of hepatic cystic echinococcosis (CE) and hepatic alveolar echinococcosis (AE). At present, laparoscopy has been comprehensively applied in the treatment of two types of liver echinococcosis. For hepatic CE treatment, both laparoscopic total pericystectomy and laparoscopic hepatectomy can achieve radical results, but the former is considered the first choice owing to its being more minimally invasive; laparoscopic subtotal pericystectomy and laparoscopic partial pericystectomy can be accepted as complementary options, considering the presence of complicated cysts and the level of laparoscopic technique in remote hospitals; laparoscopic cystectomy is simple, but it is not currently recommended for treatment of hepatic CE owing to poor efficacy and high risk of postoperative complications. For hepatic AE treatment, laparoscopy not only achieves the same radical effect as open surgery in selected patients, but also is more minimally invasive, so it has a better prospect.
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Al-Saeedi M, Ramouz A, Khajeh E, El Rafidi A, Ghamarnejad O, Shafiei S, Ali-Hasan-Al-Saegh S, Probst P, Stojkovic M, Weber TF, Hoffmann K, Mehrabi A. Endocystectomy as a conservative surgical treatment for hepatic cystic echinococcosis: A systematic review with single-arm meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009365. [PMID: 33979343 PMCID: PMC8143402 DOI: 10.1371/journal.pntd.0009365] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 05/24/2021] [Accepted: 04/06/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In patients with hepatic cystic echinococcosis (CE), treatment effectiveness, outcomes, complications, and recurrence rate are controversial. Endocystectomy is a conservative surgical approach that adequately removes cyst contents without loss of parenchyma. This conservative procedure has been modified in several ways to prevent complications and to improve surgical outcomes. This systematic review aimed to evaluate the intraoperative and postoperative complications of endocysectomy for hepatic CE as well as the hepatic CE recurrence rate following endocystectomy. METHODS A systematic search was made for all studies reporting endocystectomy to manage hepatic CE in PubMed, Web of Science, and Cochrane CENTRAL databases. Study quality was assessed using the methodological index for non-randomized studies (MINORS) criteria and the Cochrane revised tool to assess risk of bias in randomized trials (RoB2). The random-effects model was used for meta-analysis and the arscine-transformed proportions were used to determine complication-, mortality-, and recurrence rates. This study is registered with PROSPERO (number CRD42020181732). RESULTS Of 3,930 retrieved articles, 54 studies reporting on 4,058 patients were included. Among studies reporting preoperative anthelmintic treatment (31 studies), albendazole was administered in all of them. Complications were reported in 19.4% (95% CI: 15.9-23.2; I2 = 84%; p-value <0.001) of the patients; biliary leakage (10.1%; 95% CI: 7.5-13.1; I2 = 81%; p-value <0.001) and wound infection (6.6%; 95% CI: 4.6-9; I2 = 27%; p-value = 0.17) were the most common complications. The post-endocystectomy mortality rate was 1.2% (95% CI: 0.8-1.8; I2 = 21%; p-value = 0.15) and the recurrence rate was 4.8% (95% CI: 3.1-6.8; I2 = 87%; p-value <0.001). Thirty-nine studies (88.7%) had a mean follow-up of more than one year after endocystectomy, and only 14 studies (31.8%) had a follow-up of more than five years. CONCLUSION Endocystectomy is a conservative and feasible surgical approach. Despite previous disencouraging experiences, our results suggest that endocystectomy is associated with low mortality and recurrence.
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Affiliation(s)
- Mohammad Al-Saeedi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ali Ramouz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ahmad El Rafidi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Omid Ghamarnejad
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Saeed Shafiei
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sadeq Ali-Hasan-Al-Saegh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Marija Stojkovic
- Section of Clinical Tropical Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Tim Frederik Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Liver Cancer Center Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- Liver Cancer Center Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- Liver Cancer Center Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
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Akbulut S, Sahin TT, Yilmaz S. Comment on Retrospective Study of Cystic Echinococcosis in a Recent Cohort of a Referral Center for Liver Surgery. J Gastrointest Surg 2020; 24:1906-1908. [PMID: 32572688 DOI: 10.1007/s11605-020-04690-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, 44280, Malatya, Turkey.
| | - Tevfik Tolga Sahin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, 44280, Malatya, Turkey
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Dulundu E. Management of Hepatic Echinococcal Disease and Its Complications. THE SURGICAL MANAGEMENT OF PARASITIC DISEASES 2020:129-141. [DOI: 10.1007/978-3-030-47948-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Esmat G, Zayed N, Elbaz TM. Parasitic Liver Disease. ZAKIM AND BOYER'S HEPATOLOGY 2018:568-578.e4. [DOI: 10.1016/b978-0-323-37591-7.00039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Cirugía de la hidatidosis hepática. Factores de riesgo y variables asociadas al desarrollo de morbilidad postoperatoria. Revisión global de la evidencia existente. Cir Esp 2017; 95:566-576. [PMID: 29033069 DOI: 10.1016/j.ciresp.2017.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/10/2017] [Accepted: 08/19/2017] [Indexed: 12/19/2022]
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Paramythiotis D, Karakatsanis A, Bangeas P, Kofina K, Papadopoulos V, Apostolidis S, Michalopoulos A. Simultaneous Hepatic and Mesenteric Hydatid Disease-A Case Report. Front Surg 2017; 4:64. [PMID: 29209615 PMCID: PMC5702502 DOI: 10.3389/fsurg.2017.00064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 10/27/2017] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Hydatid cysts most commonly present in the liver and the lungs; however, they can appear more rarely in other locations, such as the mesentery, with a rather unclear mechanism of manifestation. Herein, we present a case of simultaneous presence of hydatid cysts in the liver and the mesentery of a young man. CASE REPORT A 39-year-old man was referred to our Department for further investigation of intermittent abdominal pain, especially in the right upper quadrant, and abdominal distension. Abdominal CT imaging revealed three calcified lesions, one in the liver, a similar adjacent to an ileal loop and one close to the urinary bladder, while antibody control was positive for echinococcal infection. The lesions were excised and the patient was discharged on the seventh post-operative day in good general condition. Post-operative control after 6 months did not show any signs of recurrence. CONCLUSION Simultaneous presence of hydatid cysts in two organs occurs in 5-13% of cases. Presence in the mesentery is extremely rare, although, should be included in the classic differential diagnosis, especially in endemic areas.
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Affiliation(s)
- Daniel Paramythiotis
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Anestis Karakatsanis
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Petros Bangeas
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Konstantinia Kofina
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Vassileios Papadopoulos
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Apostolidis
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
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Superinfection of a Dead Hepatic Echinococcal Cyst with a Cutaneous Fistulization. Case Rep Radiol 2017; 2017:9393462. [PMID: 29181218 PMCID: PMC5664247 DOI: 10.1155/2017/9393462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/06/2017] [Accepted: 09/26/2017] [Indexed: 12/28/2022] Open
Abstract
Cystic echinococcosis (CE), also known as "hydatid disease" (HD), is a zoonotic infection caused by the larval stage of Echinococcus granulosus, which infects humans as intermediate hosts through the orofecal route. Carried by the intestinal venous blood, the embryos released by the eggs of the tapeworms can reach every organ, especially the liver, turning into a hydatid cyst. Usually asymptomatic, the cysts can be incidentally detected through radiological examinations performed for other reasons. We show an unusual case of superinfection of a hydatid cyst with typical radiological features of inactivity (WHO-type CE5) with an even rarer skin fistulization passing through a subcutaneous-abdominal abscess involving the right iliac muscle.
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Peker KD, Gumusoglu AY, Seyit H, Kabuli HA, Salik AE, Gonenc M, Kapan S, Alis H. Prevention of Postoperative Bile Leak in Partial Cystectomy for Hydatid Liver Disease: Tricks of the Trade. J Gastrointest Surg 2015; 19:2228-34. [PMID: 26438482 DOI: 10.1007/s11605-015-2970-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/24/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The presence of postoperative bile leak is the major outcome measure for the assessment of operative success in partial cystectomy for hydatid liver disease. However, the optimal operative strategy to reduce the postoperative bile leak rate is yet to be defined. METHODS Medical records of patients who underwent partial cystectomy for hydatid liver disease between January 2013 and January 2015 were reviewed in this retrospective analysis. All patients were managed with a specific operative protocol. The primary outcome measure was the rate of persistent postoperative bile leak. The secondary outcome measures were the morbidity and mortality rate, and the length of hospital stay. RESULTS Twenty-eight patients were included in the study. Only one patient (3.6 %) developed persistent postoperative bile leak. The overall morbidity and mortality rate was 17.8 and 0 %, respectively. The median length of hospital stay was 5 days. CONCLUSION Aggressive preventative surgical measures have led to low persistent bile leak rates with low morbidity and mortality.
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Affiliation(s)
- Kivanc Derya Peker
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey.
| | - Alpen Yahya Gumusoglu
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Hakan Seyit
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Hamit Ahmet Kabuli
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Aysun Erbahceci Salik
- Interventional Radiology, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Murat Gonenc
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Selin Kapan
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Halil Alis
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
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Nunnari G, Pinzone MR, Gruttadauria S, Celesia BM, Madeddu G, Malaguarnera G, Pavone P, Cappellani A, Cacopardo B. Hepatic echinococcosis: clinical and therapeutic aspects. World J Gastroenterol 2012; 18:1448-1458. [PMID: 22509076 PMCID: PMC3319940 DOI: 10.3748/wjg.v18.i13.1448] [Citation(s) in RCA: 222] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 09/20/2011] [Accepted: 01/22/2012] [Indexed: 02/06/2023] Open
Abstract
Echinococcosis or hydatid disease (HD) is a zoonosis caused by the larval stages of taeniid cestodes belonging to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoccus multilocularis (E. multilocularis) and Echinococcus granulosus (E. granulosus) infection, respectively. Cystic echinococcosis (CE) has a worldwide distribution, while hepatic alveolar echinococcosis (AE) is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the pericyst; old cysts typically present internal septations and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration (PAIR)] and more effective drugs (such as benzoimidazoles) have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.
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Laparoscopic drainage of a hepatic echinococcal cyst: a case report. Case Rep Gastrointest Med 2011; 2011:107087. [PMID: 22606413 PMCID: PMC3350300 DOI: 10.1155/2011/107087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 06/26/2011] [Indexed: 12/28/2022] Open
Abstract
The Echinococcus granulosus tapeworm causes hepatic echinococcosis. It is endemic in the Mediterranean region, Middle East, and South America. Human infection is secondary to accidental consumption of ova in feces. Absorption through the bowel wall and entrance into the portal circulation leads to liver infection. This case involves a 34 y/o Moroccan male with an echinococcal liver cyst. His chief complaint was RUQ pain. The patient was treated with albendazole and praziquantel. His PMH and PSH was noncontributory. Patient was not on any other medications. ROS was otherwise unremarkable. The patient was AF VSS. He was tender to palpation in RUQ. Liver function tests were normal. Echinococcal titers were positive. CT demonstrated a large cystic lesion in the right lobe of the liver measuring 13.5 cm in diameter. The patient underwent successful laparoscopic drainage and excision of echinococcal cyst. Final pathology demonstrated degenerating parasites (E. granulosus) of echinococcal cyst.
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Sarawagi R, Keshava SN, Surendrababu NRS, Zachariah UG, Eapen EC. Budd-Chiari Syndrome Complicating Hydatid Cyst of the Liver Managed by Venoplasty and Stenting. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S202-5. [DOI: 10.1007/s00270-010-9833-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 02/18/2010] [Indexed: 12/01/2022]
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Dziri C, Haouet K, Fingerhut A, Zaouche A. Management of cystic echinococcosis complications and dissemination: where is the evidence? World J Surg 2009; 33:1266-1273. [PMID: 19350321 DOI: 10.1007/s00268-009-9982-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This systematic review was designed to provide "evidence-based" answers to identify the best treatment for a complicated hydatid cyst of the liver and the appropriate management of disseminated cystic echinococcosis. An extensive electronic search of the relevant literature was performed using Medline and the Cochrane Library. This systematic review enabled us make to determine the best treatment options for the following conditions. Liver hydatid cysts ruptured into the biliary tract: Common bile duct exploration should be conducted using intraoperative cholangiography and choledoscopy. When the biliary tract is cleared of all cystic content, T-tube drainage should be sufficient. The principal difficulty concerned the management of the large biliocystic fistula: suture or internal transfistulary drainage or fistulization. Medical treatment is indicated in association with surgery for 3 months postoperatively. During the preoperative period, endoscopic retrograde cholangiopancreatography (ERCP) combined with preoperative endoscopic sphincterotomy (ES) may decrease the incidence of postoperative external fistula. Liver hydatid cysts involving the thorax: An abdominal approach is mandatory when common bile duct drainage is required, and it may be sufficient to treat a direct rupture into bronchi. An acute abdomen, owing to Liver hydatid cysts ruptured into peritoneum, requires an emergent operation. Medical treatment should be associated. Cystic echinococcosis of the lung: Surgery is still the main therapeutic option to remove the cyst, suture bronchial fistula if necessary, followed by capitonnage. Osseous cystic echinococcosis: Wide surgical excision is recommended. Cystic echinococcosis of the heart: Cystopericystectomy is the "gold standard" procedure but is sometimes unsuitable for particular sites. Cystic echinococcosis of the kidney: Cystectomy with pericystectomy is feasible in 75% of cases; nephrectomy must be reserved for destroyed kidney. Multiple associated cystic echinococcosis locations: Complicated cysts should be treated with high priority. In case of several cysts in the liver, spleen, and peritoneum, removal of all cysts in the same intervention is indicated when there is no threat to the life of the patient. Otherwise, a planned reoperation should be considered.
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Affiliation(s)
- Chadli Dziri
- General Surgery B, Hôpital Charles Nicolle, Bd 9 avril 1938, 1006, Tunis, Tunisia.
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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.
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Affiliation(s)
- Dimitrios Filippou
- First Department of General Surgery, Piraeus General Hospital Tzaneio, Piraeus, Athens, Greece.
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Dervenis C, Delis S, Avgerinos C, Madariaga J, Milicevic M. Changing concepts in the management of liver hydatid disease. J Gastrointest Surg 2005; 9:869-77. [PMID: 15985246 DOI: 10.1016/j.gassur.2004.10.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2004] [Revised: 10/25/2004] [Accepted: 10/26/2004] [Indexed: 01/31/2023]
Abstract
Hydatid disease is a rare entity primarily affecting the population of developing countries. The parasite shuttles between the liver and lungs. but almost any organ can be invaded, forming cysts. Septation and calcification of the cysts with a high antibody titre in the patient's serum confirm the diagnosis, although more sophisticated tests have been applied recently. Surgery constitutes the primary treatment, with a variety of techniques based on the principles of eradication and elimination of recurrence by means of spillage avoidance. Minimally invasive techniques and percutaneous drainage of the cysts are now feasible because of progress in the field. The aim of this review is to collect the experience from three different institutions and to provide practical guidelines for diagnostic and therapeutic strategies.
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Affiliation(s)
- Christos Dervenis
- Unit of Liver Surgery, 1st Surgical Clinic, Agia Olga Hospital, Athens, Greece.
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Atmatzidis KS, Pavlidis TE, Papaziogas BT, Mirelis C, Papaziogas TB. Recurrence and long-term outcome after open cystectomy with omentoplasty for hepatic hydatid disease in an endemic area. Acta Chir Belg 2005; 105:198-202. [PMID: 15906915 DOI: 10.1080/00015458.2005.11679699] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND/PURPOSE Surgery is the cornerstone in the treatment of echinococcosis. The purpose of this study is to report the long-term results of partial cystectomy and omentoplasty in the management of hepatic hydatid disease. MATERIAL AND METHODS In a retrospective survey over the past 20 years (1982-2001) there were 36 patients (13 men and 23 women, with a mean age of 50 years) with hepatic echinococcosis, treated by partial cystectomy and omentoplasty. All patient data were carefully studied and short-term as well as long-term results were assessed. The cystic lesion was single in all but two cases (5.6%), located in the right lobe of the liver (69.4%), the left lobe (25%) or both lobes (5.6%). The mean size of the cyst was 12 cm in diameter (range 3 to 25 cm). The follow-up was achieved at regular intervals and recently in all, including computed tomography and specific immunological test ELIZA. It has completed a mean 12-year period (range 2 to 21 years) and in 75% of cases up to 10 years. RESULTS The mean hospital stay was 23 days (range 9 to 51 days). The morbitity was 8/36 (22%) due mainly to septic complications. The 30-day mortality was 1/36 (2.7%). The residual cavity remained for a mean of 8 months (range 4 to 18 months), while fistula formation was seen in 1/36 (2.7%). There was cure in 29 cases (80.6%) without any serological or imaging evidence of residual disease. However, recurrence was documented in 7 cases (19.4%) requiring further treatment. CONCLUSIONS Following the experience of the authors, partial cystectomy and omentoplasty may be an acceptable alternative to more radical procedures, especially in high risk cases and in developing countries.
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Affiliation(s)
- K S Atmatzidis
- Department of Surgery, Medical Faculty of the Aristotles University of Thessaloniki, G Gennimatas Hospital, Thessaloniki, Greece
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Filippou DK, Kolimpiris C, Anemodouras N, Rizos S. Modified capitonage in partial cystectomy performed for liver hydatid disease: report of 2 cases. BMC Surg 2004; 4:8. [PMID: 15222891 PMCID: PMC446201 DOI: 10.1186/1471-2482-4-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Accepted: 06/28/2004] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Several techniques have been described in liver hydatid disease surgery, with most well known partial cystectomy, capitonage and introflexion. METHODS We present a technical modification on open partial cystectomy for liver hydatid disease. We performed this operation in 2 patients with liver echinococcosis. The cyst is being unroofed and evacuated from the daughter cysts. The identified bile vessels ligated. The remnants of the anterior wall (capsule of the cyst) are anchored with sutures in the posterior wall in a manner that the cavity of the cyst disappears. RESULTS In both patients the disease eradicated. No postoperative complications were observed including bile leaking and/or abscess formation. CONCLUSIONS Our technique helps in the fast, and effective mobilization of the patient, as well as in the minimization of postoperative bile leaking.
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Affiliation(s)
- Dimitrios K Filippou
- 1Surgical Department, Piraeus General Hospital "Tzaneion", Tzanni & Afentouli str, Piraeus Greece
| | - Chariton Kolimpiris
- 1Surgical Department, Athens General Hospital "Agia Olga", 3-5 Agias Olgas str, Nea Ionia, Athens, Greece
| | | | - Spiros Rizos
- 1Surgical Department, Piraeus General Hospital "Tzaneion", Tzanni & Afentouli str, Piraeus Greece
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Abstract
Hydatidosis/echinococcosis (Echinococcus granulosus infection) is considered to be a serious problem for both public health and the livestock economy in Greece. The present paper reviews and summarizes all data available on this disease since 1970. The disease was widely prevalent long before the 1970s. At that time the annual surgical incidence rate was 12.9 per 100000 inhabitants. As a result of the seriousness of the disease, the Greek Department of Veterinary Services initiated an anti-echinococcosis campaign in 1984. When the program started, the prevalence of infection in farm animals was 82% in cattle, 80% in sheep, 24% in goats and 5% in pigs. Data obtained in a survey in Northern Greece in 1994, recorded the prevalence of CE as 100% in sheep, 56.6% in cattle, 15.4% in goats and 9.3% in pigs; sheep had not only more cysts but significantly higher rates of fertile cysts (e.g. contained viable protoscolices) than intermediate host species examined. Serologic surveys (specific IgG) in humans carried out between 1988 and 1999 had shown seroprevalence up to 29%. Surveillance in livestock species, since 1998, carried out as part of an European Union (E.U.) project, have documented the prevalences of CE in sheep (31.3%), in goats (10.3%), in pigs (0.6%) and in cattle (0%). The official campaign against this zoonosis in Greece is ongoing. It is concluded that since hydatidosis/echinococcosis is still present, surveillance and intervention measures should be continued to track the course of the infection and to eliminate risk to humans.
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Affiliation(s)
- S Sotiraki
- Laboratory of Parasitology and Parasitic Diseases, Faculty of Veterinary Medicine, Aristotle University, 540 06, Thessaloniki, Greece.
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