Department of Surgery, Organ Transplant Section, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar.
Department of Surgery, Sohag University, Sohag, Egypt.
Langenbecks Arch Surg. 2023 Aug 18;408(1):320. doi: 10.1007/s00423-023-03043-8.
Hydatid liver disease is a prevalent condition in endemic areas, particularly in the Middle East and North Africa. The use of laparoscopy as a treatment option has gained popularity. However, there is still ongoing debate regarding the optimal approach for surgical management. In this study, we present our experience with the surgical treatment of hydatid liver disease comparing conventional and minimally invasive approaches, including laparoscopic and robotic options.
We conducted a retrospective review of patients who underwent surgery for hydatid liver disease at our institution. Data was collected on the patients' clinical presentations, cyst characteristics, surgical procedures performed, intraoperative findings, and postoperative complications.
A total of 98 hydatid liver cysts were surgically managed in 57 patients. The mean age of the patients was 37.2 ± 10.2 years, with 38 (66.7%) being male. Among the patients, 14 (24.6%) underwent conventional surgery (6 partial pericystectomy, 4 total pericystectomy, and 4 liver resection), 37 (64.9%) underwent laparoscopic surgery (31 partial pericystectomy, 4 total pericystectomy, and 2 liver resection), and 6 (10.5%) underwent robotic surgery (6 partial pericystectomy). There were no significant differences between the conventional surgery and minimally invasive groups in terms of patient age, gender, cyst size, or number. However, laparotomy was associated with a higher number of total pericystectomy and liver resection procedures compared to the minimally invasive approach (P = 0.010). Nonetheless, the operation time and blood loss were comparable between both groups. Perioperative complications occurred in 19 (33.3%) patients, with 16 (84%) experiencing minor issues. Bile leak occurred in 8 (14%) patients, resolving spontaneously in 5 patients. There was no significant difference (P = 0.314) in the incidence of complications between the two groups. Conventional surgery, however, was associated with a significantly longer hospital stay (P = 0.034). During follow-up, there were no cases of mortality or cyst recurrence in our cohort.
Minimally invasive approaches for hydatid liver cysts offer advantages such as shorter hospitalization and potentially quicker recovery, making them valuable treatment options when accompanied by careful patient selection and adherence to proper surgical techniques.
肝包虫病在流行地区较为常见，特别是在中东和北非地区。腹腔镜作为一种治疗选择已经得到了广泛应用。然而，对于手术治疗的最佳方法仍存在争议。在本研究中，我们介绍了我们使用传统和微创方法（包括腹腔镜和机器人手术）治疗肝包虫病的经验。
我们对在我院接受手术治疗的肝包虫病患者进行了回顾性研究。收集了患者的临床表现、囊肿特征、手术过程、术中发现和术后并发症等数据。
共有 57 例患者的 98 个肝包虫囊肿接受了手术治疗。患者的平均年龄为 37.2±10.2 岁，男性 38 例（66.7%）。其中，14 例（24.6%）接受了传统手术（6 例部分肝包虫外囊切除术、4 例肝包虫外囊全部切除术和 4 例肝切除术），37 例（64.9%）接受了腹腔镜手术（31 例部分肝包虫外囊切除术、4 例肝包虫外囊全部切除术和 2 例肝切除术），6 例（10.5%）接受了机器人手术（6 例部分肝包虫外囊切除术）。传统手术组和微创组在患者年龄、性别、囊肿大小或数量方面无显著差异。然而，与微创方法相比，剖腹手术与更多的肝包虫外囊全部切除术和肝切除术相关（P=0.010）。尽管如此，两组的手术时间和失血量相当。19 例（33.3%）患者发生围手术期并发症，其中 16 例（84%）为轻微并发症。8 例（14%）患者发生胆漏，其中 5 例自行缓解。两组并发症发生率无显著差异（P=0.314）。然而，传统手术组的住院时间明显更长（P=0.034）。在随访期间，我们的队列中没有死亡或囊肿复发的病例。
对于肝包虫囊肿，微创方法具有住院时间短和恢复更快的优点，在精心选择患者并遵循适当的手术技术的情况下，是有价值的治疗选择。
