Hydatid cyst treatment - Laparoscopic management

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This document discusses the laparoscopic management of hydatid cysts of the liver. It details the experience of operating on 11 patients with hepatic hydatid cysts laparoscopically. Key points include: cysts were located in the right or left hepatic lobe and ranged in size from 4.5 to 18 cm. The cysts were treated laparoscopically using techniques to prevent spillage and incorporating omentum into the cyst cavity after removal. There were no immediate or long-term complications observed in patients with the longest follow up of over 8 years. The laparoscopic approach provided the benefits of minimally invasive surgery for these patients.

Healthcare

Laparoscopic Management of
Hydatid disease of Liver
Dr.Nitin Jha
Dr.Yogesh Agarwala, Dr.Sudhir Sharma,
Dr.Manish Gupta, Dr.Akshaya Panda, Dr.M.Shekhar Sharma,
Dr Ashutosh Tandon Dr. Ramandeep Singh
FORTIS HOSPITAL, NOIDA

CLINICAL FEATURES
 Asymptomatic
 Upper abdominal pain
 Upper abdominal mass /
hepatomegaly
 Obstructive jaundice

Diagnosis
 Ultrasonography
 C T Scan
 Immunologic Studies (IHA , ELISA )
 Liver function tests
 Haematology screening

Treatment of Hydatid Cyst Liver
The treatment of Hydatid cyst liver is
Surgery
UNCOMPLICATED PATIENTS
Percutaneous or Laparoscopic Evacuation Open Evacuation or Resection
Gharbi type I or II Gharbi type IV or V
Anterior cysts Posterior cysts
Peripheral cysts Central cysts
One to three cysts More than three cysts
Small cysts Large cysts
No or minimal calcification Heavy calcification
COMPLICATED PATIENTS
Percutaneous or Laparoscopic Evacuation Open Evacuation or Resection
Infected cysts meeting above criteria Infected cysts meeting above criteria
Biliary communication—indicated
Pulmonary communication—indicated
Peritoneal rupture—indicated

Obstructive Jaundice
Daughter cysts in
CBD
Cyst communicating with
Billiary tree

AIM of SURGERY
Local clearance
&
Prevention of recurrence

Essentials of Laparoscopic
management of Hydatid Cyst Liver
 Mimics exactly as we did in open era
 Cyst area to be packed off
 Scolicidal solution may be used
 Spillage to be prevented
 Thorough inspection of cyst cavity after
removal of all daughter cysts for any
billiary leak & its management
 Cyst cavity to be packed with omentum

Port Position
‘ variable ’
Right Lobe Cyst Left Lobe Cyst

Results
 Post operative period uneventful
 Mean hospital stay 3.8 days
 All benefits of MIS accrued
 Patients kept on long term medical therapy
 Longest follow up 8 years 2 months
 No immediate / late complication

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