PERICYSTECTOMY FOR LIVER HYDATID CYST: SINGLE CENTER EXPERIENCE

Öz

Objective: To analyze the results of total pericystectomy in hepatic hydatid disease. Material and Method: The data of patients who underwent total pericystectomy between 1999-2019 was evaluated. Results: Of 308 patients treated as in-patients, 32 (17 females-15 males) were found to have had total pericystectomy. Median age was 44 (range:17-73) years. Indications were: easily accessible anatomic location (20), albendazole toxicity (4), unresponsiveness to albendazol treatment (4), tumor suspicion (2), pregnancy (1) and nonadherence to albendazole use (1). Median cyst diameter was 75 mm (42-100), median cyst number was 1 (1-8). Fourteen patients had more than one cyst. Total pericystectomy alone was performed in 23 patients, while additional cysts were treated in a further 9. Of the 23 pericystectomy only patients, 18 received closed and 5 open pericystectomy. Median 36 minutes (12-78) Pringle clamping was performed in 10 patients. Median hospital stay was 6 days (1-60). Low output (<150 cc/day) bile fistula was seen in 3 patients, intraabdominal infection in 2 patients and superficial infection in 2 patients. No recurrence was observed during a median follow-up of 62 months (14-236) in 20 pericystectomy only patients. Conclusion: Pericystectomy can be performed with low morbidity and mortality in an experienced center. Recurrence risk is reduced in comparison with conservative surgery.

Anahtar Kelimeler

• Echinococcus
• hepatectomy
• radical surgery
• albendazol

KARACİĞER KİST HİDATİĞİNDE PERİKİSTEKTOMİ: TEK MERKEZ DENEYİMİMİZ

Öz

Amaç: Karaciğer kist hidatiğinde total perikistektomi uygulanan hastaların sonuçlarını irdelemek. Gereç ve Yöntem: 1999-2019 yılları arasında yatırılarak tedavi edilmiş hastaların verileri incelenerek, total perikistektomi yapılan hastalar çalışmaya dahil edilmiştir. Bulgular: Toplam 308 hastanın 32’sinde (17 kadın, 15 erkek, ortanca yaş 44 (17-73)) perikistektomi yapıldığı saptandı. Perikistektomi endikasyonları, ulaşımı kolay anatomik yerleşim (20), albendazol toksisitesi (4), albendazole cevapsız kist (4), kistik tümör kuşkusu (2), hamilelik (1) ve albendazol kullanımına uyumsuzluktu (1). Ortanca kist boyutu 75 mm (42-100), ortanca kist sayısı 1 (1-8) saptanırken, 14 hastada birden fazla kist vardı. Yirmi üç hastaya sadece total perikistektomi uygulanırken 9 hastada mevcut ek kistlere de drenaj uygulandı. Sadece perikistektomi uygulanan 23 hastadan 18’ine kapalı, 5’ine açık perikistektomi yapıldı. Perikistektomi sırasında 10 hastada ortanca 36 dk (12-78) Pringle klampajı uygulandı. Ortanca yatış süresi 6 gündü (1-60). Üç hastada düşük debili (<150 cc/gün) safra fistülü, 2 hastada karın içi enfeksiyon, 2 hastada da yüzeyel yara yeri enfeksiyonu gelişti. Sadece total perikistektomi yapılan ve ortanca 62 ay (14236) takip edilen 20 hastanın hiçbirisinde nüks gözlenmedi. Sonuç: Perikistektomi, deneyimli merkezde, seçilmiş hastalarda düşük morbidite ve mortalite ile uygulanmaktadır. Nüks riskinin de düşük olduğu gösterilmiştir.

Anahtar Kelimeler

• Ekinokok
• hepatektomi
• radikal cerrahi
• albendazol

Kaynakça

1. 1. Abdelraouf A, El-Aal AA, Shoeib EY, Attia SS, Hanafy NA, Hassani M, et al. Clinical and serological outcomes with different surgical approaches for human hepatic hydatidosis. Rev Soc Bras Med Trop 2015;48(5):587-93. [CrossRef]
2. 2. Goja S, Saha SK, Yadav SK, Tiwari A, Soin AS. Surgical approaches to hepatic hydatidosis ranging from partial cystectomy to liver transplantation. Ann Hepatobiliary Pancreat Surg 2018;22(3):208-15. [CrossRef]
3. 3. Sayek I, Yalın R, Sanaç Y. Surgical treatment of hydatid disease of the liver. Arch Surg 1980;115:847-50. [CrossRef]
4. 4. Dziri C, Haouet K, Fingerhut A. Treatment of hydatid cyst of the liver: where is the evidence? World J Surg 2004;28(8):731-6. [CrossRef]
5. 5. Yagci G, Ustunsoz B, Kaymakcioglu N, Bozlar U, Gorgulu S, Simsek A, et al. Results of surgical, laparoscopic, and percutaneous treatment for hydatid disease of the liver: 10 years experience with 355 patients. World J Surg 2005;29 (12):1670-9. [CrossRef]
6. 6. Chautems R, Buhler L, Gold B, Chilcott M, Morel P, Mentha G. Long term results after complete or incomplete surgical resection of liver hydatid disease. Swiss Med Wkly 2003;133(17-18):258-62.
7. 7. Shams-Ul-Bari, Arif SH, Malik AA, Khaja AR, Dass TA, Naikoo ZA. Role of albendazole in the management of hydatid cyst liver. Saudi J Gastroenterol 2011;17(5):343-7. [CrossRef]
8. 8. Franchi C, Di Vico B, Teggi A. Long-term evaluation of patients with hydatidosis treated with benzimidazole carbamates. Clin Infect Dis 1999;29(2):304-9. [CrossRef]

9. 9. Arif SH, Shams-Ul-Bari, Wani NA, Zargar SA, Wani MA, Tabassum R, et al. Albendazole as an adjuvant to the standard surgical management of hydatid cyst liver. Int J Surg 2008;6(6):448-51. [CrossRef]
10. 10. Buttenschoen K, Carli Buttenschoen D. Echinococcus granulosus infection: the challenge of surgical treatment. Langenbecks Arch Surg 2003;388(4):218-30. [CrossRef]
11. 11. Asenov Y, Akin M, Ibiş C, Tekant Y, Özden I. Observed or Predicted Albendazole Hepatotoxicity as an Indication for a Resection Procedure in Hepatic Hydatid Disease- A Short Series of Cases. Chirurgia (Bucur) 2019;114(4):522-7. [CrossRef]
12. 12. Bilge O, Özden İ, Birsel Y, Tekant Y, Acarlı K, Alper A, et al. The role of total pericystectomy in hepatic hydatidosis. J Hepatobiliary Pancreat Surg 1997;4:212-4. [CrossRef]
13. 13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205-13. [CrossRef]
14. 14. Gharbi HA, Hassine W, Brauner MW, Dupuch K. Ultrasound examination of the hydatic liver. Radiology 1981;139(2):45963. [CrossRef]
15. 15. Horton RJ. Chemotherapy of Echinococcus infection in man with albendazole. Trans of Roy Soc of Trop Med Hyg 1989;83:97-102. [CrossRef]
16. 16. Gomez I Gavara C, López-Andújar R, Belda Ibáñez T, Ramia Ángel JM, Moya Herraiz Á, Orbis Castellanos F, et al. Review of the treatment of liver hydatid cysts. World J Gastroenterol 2015;21:124-31. [CrossRef]
17. 17. Kapan S, Turhan AN, Kalayci MU, Alis H, Aygun E. Albendazole is not effective for primary treatment of hepatic hydatid cysts. J Gastrointest Surg 2008;12(5):86771. [CrossRef]
18. 18. Brunetti E, Kern P, Vuitton DA; Writing Panel for the WHOIWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010;114:1-16. [CrossRef]
19. 19. El Sheikh A, Al Malki A, El Shiekh MA, Al Robayan A. Non-surgical management in 336 patients of hydatid disease: 23 years experience at Riyadh Military Hospital. Hepatogastroenterology 2011;58(106):336-46.
20. 20. Sielaff TD, Taylor B, Langer B. Recurrence of hydatid disease. World J Surg 2001;25(1):83-6. [CrossRef]
21. 21. Alper A, Emre A, Acarli K, Bilge O, Ozden I, Ariogul O. Laparoscopic treatment of hepatic hydatid disease. J Laparoendosc Surg 1996;6(1):29-33. [CrossRef]
22. 22. Karabulut K, Ozden I, Poyanli A, Bilge O, Tekant Y, Acarli K, et al. Hepatic atrophy-hypertrophy complex due to Echinococcus granulosus. J Gastrointest Surg 2006;10(3):407-12. [CrossRef]
23. 23. Vennarecci G, Manfredelli S, Guglielmo N, Laurenzi A, Goletti D, Ettorre GM. Major liver resection for recurrent hydatid cyst of the liver after suboptimal treatment. Updates Surg 2016;68(2):179-84. [CrossRef]