Results of minimally invasive treatment of liver echinococcosis in comparison with traditional surgical methods

Aim. To analyze the effectiveness of PAIR in comparison with traditional surgical methods.

Materials and methods. A retrospective analysis of 199 patients who underwent surgical treatment of hepatic echinococcosis was carried out. Pericystectomy was performed on 95 (47.7%) patients (1st group), traditional echinococcectomy – 55 (27.6%; 2nd group), PAIR – 49 (24.6%; 3rd group). All patients received antihelmintic therapy for 2 months in the postoperative period.

Results. Patients of the group 3 had significantly more CE1 cysts compared with the groups 2 and 1 – 38 (77.5%) versus 19 (34.5%) and 44 (46.3%; p < 0.05) respectively. In group 2, CE2 and CE3 cysts were predominant. The duration of the operation in group 3 was significantly shorter than in group 1 and 2 – 58.2 (25–170), 194.8 (85–440) and 217 (75–540) minutes (p < 0.05). In group 1, intraoperative blood loss was higher than in group 2 – 165.4 ml (10–1000) and 106.7 ml (10–500; p < 0.05). There were no statistically significant differences between the groups in postoperative complications according to Clavien–Dindo. The duration of postoperational hospital stay of patients from the group 3 was shorter than for 1 and 2 groups – 4.3 (2–11) days, 8.03 (5–16) days and 8.08 (4–20) days (p < 0.05) respectively. There was no disease recurrence during the follow-up period.

Conclusion. The optimal treatment should be based on the stage of the disease. In CE1, the most effective method is PAIR, which is characterized by a shorter postoperational hospital stay and early recovery. In multivesicular cysts (CE2-CE3b), traditional methods of treatment are effective.

1. Shevchenko Yu.L., Nazyrov F.G. Khirurgija jehinokokkoza [Echinococcosis surgery]. Moscow: Dynasty, 2016. 288 p. (In Russian)

2. Mustapayeva A., Manciulli T., Zholdybay Z., Juskiewicz K., Zhakenova Z., Shapiyeva Z., Medetov Z., Vola A., Mariconti M., Brunetti E., Budke C.M., Khalykova M., Duisenova A. Incidence rates of surgically managed cystic echinococcosis in Kazakhstan, 2007–2016. Am. J. Trop. Med. Hyg. 2020; 102 (1): 90–95. https://doi.org/10.4269/ajtmh.19-0572

3. Sozuer E., Akyuz M., Akbulut S. Open surgery for hepatic hydatid disease. Int. Surg. 2014; 99 (6): 764–769. https://doi.org/10.9738/INTSURG-D-14-00069.1

4. da Silva A.M. Human echinococcosis: a neglected disease. Gastroenterol. Res. Pract. 2010; 2010: 583297. https://doi.org/10.1155/2010/583297

5. Nunnari G., Pinzone M.R., Gruttadauria S., Celesia B.M., Madeddu G., Malaguarnera G., Pavone P., Cappellani A., Cacopardo B. Hepatic echinococcosis: clinical and therapeutic aspects. World J. Gastroenterol. 2012; 18 (13): 1448–1458. https://doi.org/10.3748/wjg.v18.i13.1448

6. Brunetti E., Kern P., Vuitton D.A. Writing Panel for the WHOIWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010; 114 (1): 1–16. https://doi.org/10.1016/j.actatropica.2009.11.001

7. Akcan A., Sozuer E., Akyildiz H., Ozturk A., Atalay A., Yilmaz Z. Predisposing factors and surgical outcome of complicated liver hydatid cysts. World J. Gastroenterol. 2010; 16 (24): 3040–3048. https://doi.org/10.3748/wjg.v16.i24.3040

8. Abdybekova A., Sultanov A., Karatayev B., Zhumabayeva A., Shapiyeva Z., Yeshmuratov T. Epidemiology of echinococcosis in Kazakhstan: an update. J. Helminthol. 2015; 89 (6): 647–650. https://doi.org/10.1017/S0022149X15000425

9. Kern P., Menezes da Silva A., Akhan O., Müllhaupt B., Vizcaychipi K.A., Budke C., Vuitton D.A. The echinococcoses: diagnosis, clinical management and burden of disease. Adv. Parasitol. 2017; 96: 259–369. https://doi.org/10.1016/bs.apar.2016.09.006

10. Puncture, Aspiration, Injection, Re-aspiration: an option for the treatment of cystic echinococcosis. WHO Informal Working Group on Echinocossosis. World Health Organization; 2001. Available: https://apps.who.int/iris/handle/10665/67207

11. Musaev G.K., Fatyanova A.S., Levkin V.V. Principles and modern trends in liver echinococcosis treatment. Pirogov Russian Journal of Surgery = Khirurgiya. Zhurnal imeni N.I. Pirogova. 2017; 12: 90–94. https://doi.org/10.17116/hirurgia20171290-94 (In Russian)

12. Musaev G.Kh., Levkin V.V., Sharipov R.Kh. Modern trends in surgical treatment of liver echinococcosis. Sechenovskij vestnik = Sechenov Medical Journal. 2018; 4: 78–84. (In Russian)

13. Velasco-Tirado V., Alonso-Sardón M., Lopez-Bernus A., Romero-Alegría Á., Burguillo F.J., Muro A., Carpio-Pérez A., Muñoz Bellido J.L., Pardo-Lledias J., Cordero M., Belhassen-García M. Medical treatment of cystic echinococcosis: systematic review and meta-analysis. BMC Infect. Dis. 2018; 18 (1): 306. https://doi.org/10.1186/s12879-018-3201-y

14. Gomez I., Gavara C., López-Andújar R., Belda Ibáñez T., Ramia Ángel J.M., Moya Herraiz Á., Orbis Castellanos F., Pareja Ibars E., San Juan Rodríguez F. Review of the treatment of liver hydatid cysts. World J. Gastroenterol. 2015; 21 (1): 124–131. https://doi.org/10.3748/wjg.v21.i1.124

15. Kaniev Sh.A., Baimakhanov Zh.B., Doskhanov M.O., Nurlanbaev E.K., Serikuly E., Birzhanbekov N.N., Skakbaev A.S., Baiguisova D.Z., Barlybay R.A., Sadykov Ch.T., Chormanov A.T., Kausova G.K., Medeubekov U.Sh., Seisembaev M.A., Baimakhanov B.B. The results of surgical and medicinal methods of treatment of liver echinococcosis. Bulletin of Surgery in Kazakhstan. 2018; 3 (56): 29–33. (In Russian)

16. Kaniyev S., Baimakhanov Z., Doskhanov M., Kausova G., Baimakhanov B. Recent treatment results of liver echinococcosis by pair method (Puncture, Aspiration, Injection, Reaspiration). Georgian Med. News. 2020; 308: 11–14.

17. Akhan O., Salik A.E., Ciftci T., Akinci D., Islim F., Akpinar B. Comparison of long-term results of percutaneous treatment techniques for hepatic cystic echinococcosis types 2 and 3b. AJR Am. J. Roentgenol. 2017; 208 (4): 878–884. https://doi.org/10.2214/AJR.16.16131

18. Samala D.S., Gedam M.C., Gajbhiye R. Laparoscopic management of hydatid cyst of liver with Palanivelu Hydatid System over a period of 3 years: a case series of 32 patients. Indian J. Surg. 2015; 77 (Suppl 3): 918–922. https://doi.org/10.1007/s12262-014-1064-z

19. Nguyen K.T., Marsh J.W., Tsung A., Steel J.J., Gamblin T.C., Geller D.A. Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch. Surg. 2011; 146 (3): 348–356. https://doi.org/10.1001/archsurg.2010.248

20. Zaharie F., Bartos D., Mocan L., Zaharie R., Iancu C., Tomus C. Open or laparoscopic treatment for hydatid disease of the liver? A 10-year single-institution experience. Surg. Endosc. 2013; 27 (6): 2110–2116. https://doi.org/10.1007/s00464-012-2719-0

21. Vetshev P.S., Musaev G.K., Fat'yanova A.S. Echinococcosis: diagnostics and role of minimally invasive techniques (revue). Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2015; 20 (3): 47–53. https://doi.org/10.16931/1995-5464.2015347-53 (In Russian)

22. Smego R.A. Jr., Sebanego P. Treatment options for hepatic cystic echinococcosis. Int. J. Infect. Dis. 2005; 9 (2): 69–76. https://doi.org/10.1016/j.ijid.2004.08.001

23. Popa A.C., Akhan O., Petruţescu M.S., Popa L.G., Constantin C., Mihăilescu P., Creţu C.M., Botezatu C., Mastalier B. New options in the management of cystic echinococcosis – a single centre experience using minimally invasive techniques. Chirurgia (Bucur). 2018; 113 (4): 486–496. https://doi.org/10.21614/chirurgia.113.4.486

24. Köroğlu M., Erol B., Gürses C., Türkbey B., Baş C.Y., Alparslan A.Ş., Köroğlu B.K., Toslak İ.E., Çekiç B., Akhan O. Hepatic cystic echinococcosis: percutaneous treatment as an outpatient procedure. Asian Pac. J. Trop. Med. 2014; 7 (3): 212–215. https://doi.org/10.1016/S1995-7645(14)60023-7

25. Stojković M., Weber T.F., Junghanss T. Clinical management of cystic echinococcosis: state of the art and perspectives. Curr. Opin. Infect. Dis. 2018; 31 (5): 383–392. https://doi.org/10.1097/QCO.0000000000000485

26. Tolstokorov A.S., Gergenreter Yu.S., Yaitsky S.V. Jehinokokkoz pecheni [Echinococcosis of the liver]. Educational and Methodological Recommendations. Saratov, 2011. 9 p. (In Russian)

27. Muhammedoğlu B., Pircanoğlu E.M., Pişkin E., Torun S., Karadağ M., Topuz S., Köktaş S. Treatment of hepatic hydatid disease: role of surgery, ERCP, and percutaneous drainage: a retrospective study. Surg. Laparosc. Endosc. Percutan. Tech. 2020; 31 (3): 313–320. https://doi.org/10.1097/SLE.0000000000000861

28. Jaén-Torrejimeno I., Latorre-Fragua R., López-Guerra D., Rojas-Holguín A., Manuel-Vázquez A., Blanco-Fernández G., Ramia J.M. Jaundice as a clinical presentation in liver hydatidosis increases the risk of postoperative biliary fistula. Langenbecks Arch. Surg. 2021. https://doi.org/10.1007/s00423-020-02070-z