Laparoscopic treatment of hepatic hydatid disease.

BACKGROUND

Hepatic hydatid disease is now rare in Australasia. However, it remains a significant problem in endemic areas. Many cases are now managed using minimally invasive techniques and this paper reviews the current status of laparoscopic approaches to hepatic hydatid disease.

METHODS

A Medline data search was performed using the search terms of Ecchinococcos, laparoscopy, hepatectomy and pericystectomy. All publications from all publication years, including foreign language publications, were included.

RESULTS

Eight series have been published comprising five or more patients, with most utilizing techniques of laparoscopic cystectomy. All series managed Gharbi cyst types I-IV, and median operative times were between 60 and 82 min. Seven conversions were reported (3%) for problems with access or bleeding. There was one reported fatality, and between 5% and 45% (median 13%) of patients developed complications. Three cases of anaphylaxis were reported and 14 cases of bile fistula were reported (median incidence: 6%). Hospital stays were between 3 and 10 days (median stay: 3.5 days). Two series report recurrences (recurrence rates of 3% and 4%) and these were in patients not treated with preoperative albendazole.

CONCLUSION

Laparoscopic surgical techniques have been successfully applied to the treatment of hepatic hydatid cysts. While the uptake of these procedures is limited to areas of high prevalence and units with a specific interest, laparoscopic surgery is now one of the management options available to treat hepatic hydatid disease.