Laparoscopic Versus Conventional Open Treatment of Liver Hydatid: A Systematic Review and Meta-analysis of Cohort Studies

Review question / Objective: With the popularity of laparoscopy and minimally invasive technology, laparoscopy has been applied to hepatic echinococcosis. However, the safety and efficacy of traditional laparotomy and laparoscopy are unclear. This study aimed to explore the advantages and disadvantages of laparoscopy and traditional laparotomy with a Meta-analysis.To compare the efficacy and safety of laparoscopic with that of traditional laparotomy. Condition being studied: There still exist controversies about the advantages and disadvantages of laparoscopic and traditional open surgery.

Laparoscopic and open operations in the treatment of hepatic echinococcosis. Analysis of short- and long-term results

Aim: to evaluate the short- and long-term outcomes of laparoscopic and open operations in the treatment of hepatic echinococcosis.Materials and methods. The results of laparoscopic and open echinococcectomies performed from 2013 to 2020 were retrospectively studied. Laparoscopic operations were considered the method of choice. Open operations were performed in cases with contraindications to the laparoscopic approach.Results. In total, 57 patients were operated: 47 laparoscopically (including robotic approach in 4 cases), 9 patients underwent open surgery. Radical procedures prevailed among laparoscopic cystectomies: 46 (98%). In the groups of laparoscopic/open cystectomies, partial pericystectomy was performed in 1/3 of patients, subtotal – in 24/4, total – in 13/0, and liver resection – in 9/2 patients, respectively. Laparoscopic procedures were performed mainly for types 1 and 3 of cysts, open procedures – for type 2 (WHO), recurrent and extrahepatic abdominal cysts were indication for open surgery. The frequency of severe complications did not differ between the groups. In the laparoscopic group, 1 (2%) patient died. After laparoscopic cystectomies, the mean (median) hospital stay (8 vs 10 days) and duration of abdominal drainage (10 vs 12 days) were significantly shorter. Relapse occurred only after conservative cystectomies, in one patient in each group.Conclusion. Laparoscopic radical surgery for liver hydatid cysts may be the method of choice if performed in a specialized HPB center. Patient selection criteria should be based on the center's experience in laparoscopic liver surgery.

Clinical and pathogenetic aspects of the complications after surgical treatment of hepatic echinococcosis

Aim. To identify factors influencing effectiveness of surgical approaches in hepatic echinococcosis, depending on the location, size and stage of development of the cyst.Material and methods. From 2015 to 2017 the experience of surgical treatment of 98 patients with liver echinococcosis who underwent percutaneous (PAIR – 23 and PEVAC – 29 patients) and laparoscopic (46 patients) interventions was considered.Results. After the PAIR, a complication was noted in 1 (16.7%) case of isolated use with a CE3 cyst. Various complications were noted in 3 (60%) cases with a cyst puncture of more than 4 cm, and in 2 of them with CE2 and CE3. The average time for evacuating the cysts contents when performing the PEVAC technique was 5 days. Hemorrhagic fluid in drainage was noted in 6.9% of cases, biliary fistula – in 13.8%. Accumulation of fluid and suppuration in the residual cavity were identified in 34.5%. Taking into account the size of the cysts, the complication rate after PEVAC was 9.1% for cysts ≤6 cm vs 50% for cysts >6 cm. Various difficulties with manipulations during laparoscopic echinococcectomy were noted more often with CE2–4. So, difficulties with aspiration or removal of cyst contents more often arose with CE4. The incidence of complications after drainage removal was 17.9%, of which fluid accumulation was in 14.3% and residual cavity suppuration in 3.6% of cases.Conclusion. The US criteria, main indications and tactical and technical aspects for performing PAIR and PEVAC methods, as well as for performing laparoscopic echinococcectomy, and criteria for assessing the required volume of percytectomy for an adequate abdominalization of fibrous capsule have been clarified.

Results of minimally invasive treatment of liver echinococcosis in comparison with traditional surgical methods

Aim. To analyze the effectiveness of PAIR in comparison with traditional surgical methods.Materials and methods. A retrospective analysis of 199 patients who underwent surgical treatment of hepatic echinococcosis was carried out. Pericystectomy was performed on 95 (47.7%) patients (1st group), traditional echinococcectomy – 55 (27.6%; 2nd group), PAIR – 49 (24.6%; 3rd group). All patients received antihelmintic therapy for 2 months in the postoperative period.Results. Patients of the group 3 had significantly more CE1 cysts compared with the groups 2 and 1 – 38 (77.5%) versus 19 (34.5%) and 44 (46.3%; p < 0.05) respectively. In group 2, CE2 and CE3 cysts were predominant. The duration of the operation in group 3 was significantly shorter than in group 1 and 2 – 58.2 (25–170), 194.8 (85–440) and 217 (75–540) minutes (p < 0.05). In group 1, intraoperative blood loss was higher than in group 2 – 165.4 ml (10–1000) and 106.7 ml (10–500; p < 0.05). There were no statistically significant differences between the groups in postoperative complications according to Clavien–Dindo. The duration of postoperational hospital stay of patients from the group 3 was shorter than for 1 and 2 groups – 4.3 (2–11) days, 8.03 (5–16) days and 8.08 (4–20) days (p < 0.05) respectively. There was no disease recurrence during the follow-up period.Conclusion. The optimal treatment should be based on the stage of the disease. In CE1, the most effective method is PAIR, which is characterized by a shorter postoperational hospital stay and early recovery. In multivesicular cysts (CE2-CE3b), traditional methods of treatment are effective.

Optimization of surgical tactics in hepatic echinococcosis

Aim. Optimization of the surgical tactics in hepatic echinococcosis.Material and methods. From 2009 to 2021, 56 patients with hepatic echinococcosis have been operated: 6 patients underwent PAIR, 7 – open echinococcectomy, 18 – pericystectomy (“ideal echinococcectomy”) and 16 – anatomical hepatectomy (S2/3, S6/7 bisegmentectomy) or atypical resection. In 7 cases hemigepatectomy has been performed, in 2 – combined interventions have been performed for echinococcosis relapse of the abdominal cavity.Results. The duration of minor hepatic resection was shorter than pericystectomy and major hepatic resection. The smallest blood loss was noted in patients who underwent open echinococcectomy, anatomical and atypical hepatectomy. No complications after PAIR were noticed. The lowest incidence of postoperative complications, including biliary complications, was found after hepatic resection interventions. The lenths of hospital stay after hepatic resections was significantly shorter compared to ecinococcectomy and pericystectomy. The reccurence of hepatic echinococcosis relapse was detected in 4 (66.7%) patients after PAIR and 2 (28.6%) patients after ecinococcectomy.Conclusion. Organ-preserving techniques should be a priority in the surgical treatment of hepatic echinococcosis. The best results in terms of the early postoperative complications frequency in the hepatic echinococcosis treatment were demonstrated by minor hepatic resections. Open echinococcectomy should be performed only for central location of large cysts and (or) their massive contact with the liver vessels. Minimally invasive resection technologies demonstrate optimal short- and long-term results. Major hepatectomy should be performed very selectively and only in those cases when they have advantages over other methods, and their implementation does not lead to a loss of more than 20% of healthy hepatic parenchyma. The best long-term results showed pericystectomy and hepatectomy in comparison with echinococcectomy.

Сurrent status of the surgical treatment of liver echinococcosis

The literature review presents the world and russian experience in the surgical treatment of patients with hepatic echinococcosis over the last two decades. The most important aspects of the epidemiology and biology of echinococcus for the surgeon have been considered. Special attention is paid to the modern diagnosis of the disease, to the choice of volume and method of surgical treatment, according to WHO classification. The approaches to minimally invasive, laparoscopic and robotic operations of liver echinococcosis had been reviewed.

Hepatic echinococcosis: difficulties in diagnosis at the early stages of progression and with complications (literature review)

To demonstrate the possible difficulties in the diagnosis of hepatic echinococcosis, that a specialist in ultrasound diagnostics and a radiologist may encounter in everyday practice, russian and foreign literature as well as our own experience have been reviewed. With high accuracy and specificity of ultrasonography in the differential diagnosis of echinococcal cysts, incorrect interpretation is possible in the presence of mural hemorrhages and (or) hemorrhagic clots in a nonparasitic cyst, which aren’t also visible in ultrasonography and can imitate elements of the chitinous membrane. The degree of prevalence of the process, the exclusion of damage to the lungs and other organs of the abdominal cavity are important. In such cases CT scan is the most convenient and accurate diagnostic method due to its high spatial and temporal resolution, standardization and availability. In the most difficult cases the capabilities of MRI are used in the comparison of diffusion-weighted images and apparent diffusion coefficient, which also makes it possible to diagnose cystic neoplasms. Ultrasonography is a diagnostic technology that is still the most commonly used to differentiate cavity structures; however, all dubious clinical observations should be further examined by using CT or MRI.

“Complex” hepatic echinococcosis

Aim. To study the long-term results of surgical treatment in patients with “complex” hepatic echinococcosis.Materials and methods. The results of surgical treatment of 118 patients with hepatic echinococcosis from 2015 to 2020 at the A.V. Vishnevsky National Medical Research Center of Surgery were analyzed. The term “complex” hepatic echinococcosis has been proposed. A comparative analysis of the number and type of complications and surgical interferences 2 groups of patients was carried out: 66 patients with hepatic echinococcosis, 52 patients with complex hepatic echinococcosis.Results. During the observation period, no any recurrence was recorded. 55 (44%) of 118 patients had complex hepatic echinococcosis. Isolated liver damage was found in 74% of cases, combined liver and lung damage in 20% cases and with other organs – in 6%. In most cases, pericystectomy was performed (82%), 8% of patients underwent atypical hepatectomy, 4% – segmental resection, 3% – laparoscopic intervention, 3% – hemihepatectomy. Postoperative complications were recorded in 22 (18,6%) of cases. Accumulations of bile and biliary fistulas formed in 45% of cases, pneumotothorax or hydrothorax – in 23%, wound abscess – in 18%, hematomas in the hepatectomy zone – in 14% of the cases.Conclusion. Surgical treatment of complex hepatic echinococcosis requires an individual approach to the choice of the operation option. Preference should be given to parenchyma-preserving radical operations. When the liver lobe is totally replaced with a hydatid cyst and in case of cystobiliary fistulas hemihepatectomy should be performed, and it is acceptable to leave the fibrous capsule on large tubular structures.