presentation china-hydatid _mpeg
TRANSCRIPT
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Our attempt may fail, but wemust never fail to make an
attempt.
One can conquer almost any fear if you will
make up your mind to do so.So I attempted my first Laparoscopic
Hydatid cystectomy with Omentoplasty in
low resource settings.
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Hydatidosis caused by Echinococcus
Granulosus is endemic parasitic disease in
Mediterranean countries, some parts ofNorthern china and some parts of Indian
subcontinent.
Dogs are definitive hosts and sheep asintermediate hosts, Humans are accidental
intermediate hosts .Once within humans,
ingested eggs hatch in duodenum to release
oncospheres ( Larvae ) which burrow into thejejunal submucosa and enter the veins or
lymphatics to reach liver which acts as an
effective filter for most of the Larvae.
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However there may be other sites also involved .These are:
ORGAN PERCENTAGE
Liver 55-75
Lungs 18-35Peritoneal cavity 10-16
Kidneys 1-4
Spleen 2-3
Uterus & Adnexa 0.5-1.5
Retroperitoneum 0.5-1.5
Pancreas 0.3-0.8
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Asymptomatic
Hepatomegaly Jaundice
Urticaria
Malaise
Abdominal PainAbdominal Mass
Fever
Anorexia
Cough
Clinical features of Hepatic Hydatid disease:
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Investigations:
3) Imaging studies ---
Plain X-ray abdomen --- may show elevated right hemi-diaphragm
Ultrasonography--- due to its easy availability and affordability and itsdiagnostic sensitivity, it is the imaging test of choice.
CT scan--- This gives the maximum information of the position and extent
of the hydatid disease.
MRI -- however it does not yield any extra information as compared to CT.
1) Routine Hematology ---- which may show elevated total leucocytes, and
eosinophia
2) Casonis Test --- However obsolete due to its low specificity & sensitivity and
also due to its risk of anaphylaxis.
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IHA- Indirect Haemagglutination testCFT-complement fixation test
LT-Latex agglutination test
IEP-Immunoelectrophoresis
ELISA- Enzyme linked immunosorbent assay
BDT-Basophil degranulation test.
The strategy for serological diagnosis should be initial screening with
highly sensitive tests like IHA or LT followed by confirmation by highly
specific tests like ELISA.
while CFT has a role in monitoring progress after surgical treatment as
it turns negative within 12 months of cure.
Recently there are reports that BDT has high sensitivity and it
becomes negative within a week of cure .
4) Various Immunological tests
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1) Rupture---
Intraperitoneal
Intra-Biliary
Intrapleural
Intrabronchial
Intra adjacent organs
2) Pressure effects like obstructive jaundice.
3) Cholangitis, biliary cirrhosis.
4) Secondary infection.
5) Allergic reaction---
Urticaria
Bronchospasm
Anaphylaxis
Eosinophilia
Complications of Hepatic Hydatid Cysts.
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1) Medical - Albendazole,
2) PAIR - Puncture Aspiration Injection , Re-aspiration.
This was proposed in 1986 by a Tunisean team.
3) Surgery - Open or Laparoscopic.
Surgery remains the mainstay of treatment for Hepatic Hydatid disease,which may be
Marsupilization
Total pericystectomy
Partial Pericystectomy Partial Pericytectomy with Omentoplasty
Liver resections.
The First laparoscopic treatment for Hydatid cyst of liver was published
in 1994 by Bichel et al.
Treatment:
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Here in our patient we gave albendazole pre-operatvely, 10
mg/kg body weight for 2 weeks before surgery.
Position of patient was supine with Left lateral tilt with Sandbag
under the patient on Right side.
10 mm camera port at umbilicus by open technique,pneumoperitoneum achieved, rest all working ports under vision,
10 mm epigastric, 5 mm Right mid-clavicular , 5 mm Left
subcostal region.
Cyst identified, adhesions gently separated and cyst surfaceexposed.
Penetration of cyst wall with trocar, aspiration of contents done.
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Cavity washed with Normal saline and Hypertonic saline.
Once the returning fluid is clear , the telescope is introduced
in the cyst cavity to visualize the interior for any cyst-biliary
communication , which was not there.
Telescope is then taken out , washed thoroughly and cleanedbefore reintroduction in peritoneal cavity.
All the laminated membranes carefully removed, omentum
taken into the cavity and sutured with cavity edges.
Post-operatively patient was followed up every month and is
now symptomless past six months.
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Laparoscopic treatment of hepatic hydatid cyst should not beregarded as a new technique rather it is new and minimally
invasive access to perform established surgical technique and
it follows the basic surgical principles of treating hydatid cyst,
which are evacuation of cyst contents, prevention of spillage,sterilization of cavity with scolicidal agents and management of
the residual cavity.
Hence, Laparoscopic treatment for Liver Hydatid Cyst is safe
and effective in selected patients and offer all the advantage of
minimal invasive surgery with low morbity and early recovery.
Conclusion
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