BACKGROUND Liver hydatid cysts(LHC)liver requires effective surgical treatment.Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.AIM To evaluate the outcomes o...BACKGROUND Liver hydatid cysts(LHC)liver requires effective surgical treatment.Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.AIM To evaluate the outcomes of pericystectomy and its efficacy as a treatment modality for cystic echinococcosis(CE).METHODS Thirty-eight patients were analyzed after open total pericystectomy at the University Hospital of Cologne between January 2006 and January 2024.Demographic,clinical,and laboratory parameters were collected retrospectively.Intraoperative data and postoperative complications were documented and classified using the Clavien-Dindo classification.Throughout the follow-up period,patients underwent regular clinical,serological,and sonographic evaluations both at the outpatient department and by their general physicians.RESULTS Fifty-four cysts were treated with open total pericystectomy.Multiple cysts were found in 42.2%of cases.Singular cysts occurred in 57.8%.The right hepatic lobe was affected in 66.7%.Ectopic cysts occurred in 4 patients in the lung(n=3)and spleen(n=1).Median cyst size was 6.78 cm×5.92 cm(range:1.4-20.0 cm).The median surgical time of pericystectomy was 189 minutes(range:78-455 minutes)with a median blood loss of 400 mL(range:100-1400 mL).The complication rate(Clavien-Dindo>III)was 21.1%.The average hospital stay was 12.5 days.No recurrent disease could be detected after a median follow-up time of 97 months(range:4-216 months).No recurrent cyst manifestation,postoperative liver failure or death was observed.CONCLUSION The presented surgical procedure known as open total pericystectomy is a safe surgical technique in treatment of cystic echinococcosis.展开更多
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 ...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.展开更多
Echinococcosis or hydatid disease is induced mainly by Echinococcus granulosus and occasionally by Echinococcus multilocularis(alveolaris)and affects the liver predominantly.Hepatic alveolar echinococcosis is similar ...Echinococcosis or hydatid disease is induced mainly by Echinococcus granulosus and occasionally by Echinococcus multilocularis(alveolaris)and affects the liver predominantly.Hepatic alveolar echinococcosis is similar to carcinoma in appearance,and without treatment,it can lead to death.Diagnosis is based on current imaging modalities.Surgical management is the cornerstone of treatment.Complete removal of the cyst(total pericystectomy or hepatectomy)ensures a permanent cure and should be the first-choice treatment for cystic disease.Cyst evacuation,partial cystectomy,and drainage or omentoplasty,may be alternative choices in difficult cases.Albendazole,mebendazole and praziquantel are options for treating small cysts and preventing recurrence after surgery.Despite the efforts,alveolar echinococcus is not usually amenable to surgical management,except in the early stage,which is less common,and management by albendazole is indicated.However,there are few recent reports of major operations(ex-vivo hepatectomy,autotransplantation and vascular reconstruction)in advanced stages.展开更多
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 ...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.展开更多
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...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.展开更多
文摘BACKGROUND Liver hydatid cysts(LHC)liver requires effective surgical treatment.Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.AIM To evaluate the outcomes of pericystectomy and its efficacy as a treatment modality for cystic echinococcosis(CE).METHODS Thirty-eight patients were analyzed after open total pericystectomy at the University Hospital of Cologne between January 2006 and January 2024.Demographic,clinical,and laboratory parameters were collected retrospectively.Intraoperative data and postoperative complications were documented and classified using the Clavien-Dindo classification.Throughout the follow-up period,patients underwent regular clinical,serological,and sonographic evaluations both at the outpatient department and by their general physicians.RESULTS Fifty-four cysts were treated with open total pericystectomy.Multiple cysts were found in 42.2%of cases.Singular cysts occurred in 57.8%.The right hepatic lobe was affected in 66.7%.Ectopic cysts occurred in 4 patients in the lung(n=3)and spleen(n=1).Median cyst size was 6.78 cm×5.92 cm(range:1.4-20.0 cm).The median surgical time of pericystectomy was 189 minutes(range:78-455 minutes)with a median blood loss of 400 mL(range:100-1400 mL).The complication rate(Clavien-Dindo>III)was 21.1%.The average hospital stay was 12.5 days.No recurrent disease could be detected after a median follow-up time of 97 months(range:4-216 months).No recurrent cyst manifestation,postoperative liver failure or death was observed.CONCLUSION The presented surgical procedure known as open total pericystectomy is a safe surgical technique in treatment of cystic echinococcosis.
基金supported by grants from The National Natural Science Foundation of China(No.81160199)the National SupProgram for Supporting Researches of Scienceand Technology of China(No.2009BAI82B06)+1 种基金Major Health Research Projects of Xinjiang Production and Con-struction Corps,Xinjiang,China(No.2010GG54)Ma-jor Research Projects of Shihezi University,Xinjiang,China(No.gxji2008-zdgg06)
文摘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.
文摘Echinococcosis or hydatid disease is induced mainly by Echinococcus granulosus and occasionally by Echinococcus multilocularis(alveolaris)and affects the liver predominantly.Hepatic alveolar echinococcosis is similar to carcinoma in appearance,and without treatment,it can lead to death.Diagnosis is based on current imaging modalities.Surgical management is the cornerstone of treatment.Complete removal of the cyst(total pericystectomy or hepatectomy)ensures a permanent cure and should be the first-choice treatment for cystic disease.Cyst evacuation,partial cystectomy,and drainage or omentoplasty,may be alternative choices in difficult cases.Albendazole,mebendazole and praziquantel are options for treating small cysts and preventing recurrence after surgery.Despite the efforts,alveolar echinococcus is not usually amenable to surgical management,except in the early stage,which is less common,and management by albendazole is indicated.However,there are few recent reports of major operations(ex-vivo hepatectomy,autotransplantation and vascular reconstruction)in advanced stages.
文摘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.
文摘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.
