Laparoscopic Pericystectomy for Hepatic Hydatid Cysts: Prospective Evaluation of Feasibility and Outcome
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Objectives: To evaluate the outcomes of laparoscopic management of liver hydatidosis Patients & Methods: The study included 17 patients; 6 males and 11 females had CT confirmed diagnosis of hydatid cyst. Preoperative laboratory and radiological evaluation was conducted and cysts of Gharbi types II and III were included in the study. Medical therapy was used for 4 weeks before and 12 weeks after surgery. All patients had laparoscopic pericystectomy with omentoplast and drainage of the residual cyst with a negative suction catheter. Results: Right upper quadrant pain was the main presenting symptom in 12 patients, 3 patients were detected incidentally during routine abdominal ultrasonography for unrelated causes, and 2 patients were unresponsive to treatment and showed recent enlargement of size. Total number of cysts was 24 cysts; 3 cysts were of Gharbi type II and 21 cysts were type III. Mean cystic diameter was 7±2.2 cm. Seven cysts were in the superior most region of the liver (segment VII and VIII), and 17 cysts were in the easily accessible anteroinferior aspect of the liver (segments II to VI). Aspirated cystic fluid of 5 cysts was bacterially infected. Mean operating time was 79.1+23.8 minutes. No open-conversion was required with only 2 patients had minimal intraoperative spillage. Omentoplasty was performed in 12 patients but was not feasible in the other 5 patients who required peritoneal drainage. Early postoperative complications included low-grade fever not accompanied by leucocytosis in 6 patients and persistent drainage exceeding 4 days in 3 cases. Mean hospital stay was 6.4±1.2 days and with a mean duration of 12.4±4.3 months. Recurrence of a cystic lesion on serial imaging was noted within 6 months in 3 patients (17.6%). Conclusion: Laparoscopic pericystectomy for properly selected hepatic hydatid cyst is a safe and effective procedure with minimal postoperative morbidities and low recurrence rate.