18th iasgo congress - istanbul, october 8-11, 2008 surgical treatment of large liver hydatidosis –...

18th IASGO Congress - Istanbul, October 8-11, 2008

SURGICAL TREATMENT OF LARGE LIVER HYDATIDOSIS – A COMPARISON OF DIFFERENT PROCEDURES

Dr. Avdyl Krasniqi – Kosova( Prishtina )Dr. Viktor QERESHNIKU – Albania ( Tirana )

E bp. A.Krasniqi¹, V. Qereshniku², B. Elezi ² , D. Limani ¹, F. Hoxha ¹,, A. Beqiri ², B. Bicaj ¹, A. Gjata ² , R.

Musa ¹, S. Agolli ² , G. Spahija ¹, A. Kerciku ² , S. Krasniqi³, L. Gashi-Luci ³

¹University Clinical Centre of Kosova, Prishtina, Kosovo

² University Hospital Centre “Mother Theresa”, Tirana, Albania

³ University of Prishtina,Faculty of Medicine, Prishtina, Kosovo


INTRODUCTION


INTRODUCTION

• Liver hydatidosis has been a common pathology for years in the surgical departments of our hospitals;

• Surgery combined with scolicidal therapy is the most often used treatment modality;

– Mainly treated large liver hydatid cysts of:• Different topographic locations (T)¹

• Different levels of complication (C1-C6)» ¹Kjosev KT, Losanoff JE: J Gastroenterol Hepatol. 2005;20:352-9


INTRODUCTION

• Although concept of management of liver hydatidosis is changing, surgery is still gold standard for complete cure²

• There is still contraversy regarding the appropriate surgical technique³

• Open surgical procedures: – Tissue sparing techniques; endocystectomies/partial

pericystectomy– Radical procedures; complete pericystectomy/resection

» ²Dervenis et al.:Journal of Gastrointestinal Surgery 2005;9:869-877.

» ³Skroubis et.: World Journal of Surgery 2002;26:704-708.


OBJECTIVE

• To analyze the outcome of different surgical procedures that were used for treatment of 545 patients with large liver hydatid cysts.


MATERIAL AND METHODS

• A retrospective study• Chart review of patients with large liver hydatid cysts

treated surgically over 15 years period in two university hospitals with almost similar settings in terms of patients, hospital resources and surgical teams:

• University Clinical Centre of Kosova (UCKK) in Prishtina• University Hospital Centre “Mother Theresa” in Tirana

(UHCT), Albania


LARGE CYSTSPreoperative US/CT diameter < 12 cm;Different CE stages; WHO/Gharbi Classif.



PATIENTS• Total 545

– Goup I 293 (UCCK - Prishtina• Female 182 (62.08%)• Male 111 (37.92%)

– F:M = 1.63:1

– Group II 252 (UHC – Tirana)

• Age– Median 37 years (Range 17-81)

• 20-40 range most often attacked



TREATMENT – FOLLOWED PRINCIPLES

• Choice of procedure depends from:– Size of the cyst– Localization– Intrabiliary communication– Age– Equipment– Surgical team


TREATMENT – FOLLOWED PRINCIPLES• Intraoperative intences:

- Adhesion dissection/ freed the cyst from other organs;- Prevention of intraperitoneal spillover and intracystic scolicidal therapy;



- Removal/ennucleation of cysts



–Total/partial pericystectomy



- Careful treatment of the cavity- closure of eroded bile channels-Check main bile channel for daughter cysts (selectively)-Pre/post operative ERCP/removal of daughter cysts (rarely)



–Omentoplication, T-tube (selectively)

–Drainage; Cavity and sub hepatic


RESULTS

Localisation (%) in the Liver

62.75%27.80%

18.90%

Right Lobe

Left Lobe

Both Lobes


Main Clinical Signs

53.6

30.9

19.5 17.8

76.6

50.441.3

20.6

65.1

40.6

30.4

19.2

0

1020

3040

5060

7080

90

Hepatomegaly Abdominalmass

Temperature Joundice

%

Groupe I

Groupe II

Average


SURGICAL PROCEDURES

202

2556

10

192

46

5 9

394

71 61

19

0

50

100

150

200

250

300

350

400

450

Endocyst

&part

ial/subto

tpericyste

cto

my

Tota

l peric/liv

er

resec

Endocyst&

capitonnage

Exte

rnal dra

inage

Nu

mb

er

of

pts

.

Groupe I

Groupe II

Total


Surgical Procedures in %

Endocyst & partial/subtot pericystect.

69%

Total peric/liver resec12%

Endocyst&capitonnage

11%

External drainage

8%


CYST LOCALISATION IN THE LIVER

SURGICAL PROCEDURES

Mean postoperative hospital days

16.6

34

0 10 20 30 40

Group I

Group II

Postop. hospital stay

• Mean postoperative hospital days:– 25.3 (min. 5, max. 93)

• Gr. I: 16.6 (min. 5, max. 71)• Gr. II: 34 (min. 9, max. 93)

• Bile duct exploration: – 95 pts (17.43%)

• Gr. I: 43 pts (14.6%)• Gr. II: 52 pts (20.6%)


Postoperative Complications

0

5

10

15

20

25

30%

Group I 4.99 15.07 6 3.87 4.4 0.34

Group I I 4.7 1.15 28.1 1.19 4.36 3.17

Average 4.84 8.11 17.05 2.82 4.38 3.15

Billiary fistula

PleuritisWound

infectionAbscessus

sd.Abscessus

of cavityMortality


CONCLUSION

• This study showed that:– Enucleation of endocysts, clean up of detritus and

other materials from cavity, partial pericystectomy, closure of eroded bile channels, introflexion of pericystic edges and omentolplasty, was most often applied.

– Marsupialization, endocystectomy with capitonnage as well as external drainage that were used in the past decades, had a higher postoperative complication rate and longer hospital stay compared to the previous procedure.


– Radical surgical approach to a benign pathology such as LH is not an appropriate treatment modality for hospitals with limited resources.

• Therefore:– For large and complicated LH we recommend

endocystectomy, partial pericistectomy with omentoplasty.


THANK YOU!

18th iasgo congress - istanbul, october 8-11, 2008 surgical treatment of large liver hydatidosis –...

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albania slide

introduction slide

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large liver hydatid

surgical teams

university hospitals

surgical departments