Method for elimination of residual cavity with rigid fibrous capsule in patients with hepatic echinococcosis and comorbidity

Aim. To improve the results of organ-preserving surgeries for hepatic echinococcal cysts with rigid fibrous capsule.

Materials and methods. The study analyzed the results of surgical treatment of 221 patients with hepatic echinococcosis that was performed from 2016 to 2023. The main group included 94 patients (2020–2023), who underwent laparotomic or laparoscopic echinococcectomy followed by additional treatment of the residual cavity by the suggested method (113 cysts in total). The comparison group included 88 patients (2016–2019) who underwent standard interventions (108 cysts in total).

Results. A treatment method for the residual cavity is selected with regard to the condition of the fibrous capsule. In case of elastic fibrous capsule, resections were performed in 1.7% of patients in the comparison group and 1.9% in the main group. Laparoscopic echinococcectomy was performed in 29.1% and 38.5% of cases, open echinococcectomy – in 69.2% and 59.6%, respectively. In case of rigid fibrous capsule, resections were made in 4.3% of patients in the comparison group and in 8% in the main group. Laparoscopic echinococcectomy was performed in 8.5% and 23.9% of cases, open echinococcectomy – in 87.2% and 68.2%, respectively.

Conclusion. The suggested method of additional treatment for the residual cavity in cases of open and laparoscopic interventions enables the risk of early complications to be reduced from 19.1% to 4.5%, and from 16% to 3.4% within 3 months after surgery.

1. Shevchenko Y.L., Nazyrov F.G. Khirurgiya ekhinokokkoza: monografiya [Surgery of echinococcosis: monograph]. Moscow: Dinastiya, 2016. 288 p. (In Russian)

2. Brunetti E, Kern P, Vuitton DA. 2010. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 114:1–16. doi:10.1016/j.actatropica.2009.11.001.

3. Bastid C, Terraz S, Toso C, Chappuis F, Spahr L, Bresson-Hadni S. Actualités sur l’échinococcose kystique hépatique [Update on cystic echinococcosis of the liver]. Rev Med Suisse. 2021 Sep 1;17(748):1466-1473. French. PMID: 34468098.

4. Zhao ZM, Yin ZZ, Meng Y, Jiang N, Ma ZG, Pan LC, Tan XL, Chen X, Liu R. Successful robotic radical resection of hepatic echinococcosis located in posterosuperior liver segments. World J Gastroenterol 2020; 26(21): 2831-2838.

5. Jaén-Torrejimeno I, López-Guerra D, Rojas-Holguín A, De-Armas-Conde N, Blanco-Fernández G. Surgical treatment of liver hydatid cyst in elderly patients: A propensity score-matching retrospective cohort study. Acta Trop. 2022 Aug;232:106466. doi: 10.1016/j.actatropica.2022.106466.

6. Baraket O., Moussa M., Ayed K., Kort B., Bouchoucha S. Predictive factors of morbidity after surgical treatment of hydatid cyst of the liver // Arab J. Gastroenterol., 15 (2014), pp. 119-122, 10.1016/j.ajg.2014.05.004.

7. Bockhorn M., Sotiropoulos G.C., Sgourakis G., Neuhaus J.P., Molmenti E.P., Lang H., Frilling A., Broelsch C.E. Major liver resections in the elderly - Is an aggressive approach justified? // Int. J. Colorectal Dis., 24 (2009), pp. 83-86, 10.1007/s00384-008-0571-4.

8. Cho S.W., Steel J., Tsung A., Marsh J.W., Geller D.A., Gamblin T.C. Safety of liver resection in the elderly–How important is age? // Ann. Surg. Oncol., 18 (2011), pp. 1088-1095, 10.1245/s10434-010-1404-6.

9. Kumari S., Semira C., Lee M., Lee B., Wong R., Nott L., Shapiro J., Gibbs P. Resection of colorectal cancer liver metastases in older patients // ANZ J. Surg., 90 (2020), pp. 796-801, 10.1111/ans.15750.

10.