Clinical and pathogenetic aspects of the complications after surgical treatment of hepatic echinococcosis

Aim. To identify factors influencing effectiveness of surgical approaches in hepatic echinococcosis, depending on the location, size and stage of development of the cyst.

Material and methods. From 2015 to 2017 the experience of surgical treatment of 98 patients with liver echinococcosis who underwent percutaneous (PAIR – 23 and PEVAC – 29 patients) and laparoscopic (46 patients) interventions was considered.

Results. After the PAIR, a complication was noted in 1 (16.7%) case of isolated use with a CE3 cyst. Various complications were noted in 3 (60%) cases with a cyst puncture of more than 4 cm, and in 2 of them with CE2 and CE3. The average time for evacuating the cysts contents when performing the PEVAC technique was 5 days. Hemorrhagic fluid in drainage was noted in 6.9% of cases, biliary fistula – in 13.8%. Accumulation of fluid and suppuration in the residual cavity were identified in 34.5%. Taking into account the size of the cysts, the complication rate after PEVAC was 9.1% for cysts ≤6 cm vs 50% for cysts >6 cm. Various difficulties with manipulations during laparoscopic echinococcectomy were noted more often with CE2–4. So, difficulties with aspiration or removal of cyst contents more often arose with CE4. The incidence of complications after drainage removal was 17.9%, of which fluid accumulation was in 14.3% and residual cavity suppuration in 3.6% of cases.

Conclusion. The US criteria, main indications and tactical and technical aspects for performing PAIR and PEVAC methods, as well as for performing laparoscopic echinococcectomy, and criteria for assessing the required volume of percytectomy for an adequate abdominalization of fibrous capsule have been clarified.

1. Shevchenko Yu.L., Nazirov F.G., Ablicov Yu.A., Khudaibergenov Sh.N., Musaev G.Kh., Vasilashko V.I., Ablitsov A.Yu. Surgical treatment of pulmonary hydatid cyst. Bulletin of Pirogov National Medical & Surgical Center. 2016; 11 (3): 14–23. (In Russian)

2. Robles R., Parilla P. Abscesos y quistes hepáticos. Guias Clinicas de la A.E.C. Cirugía Hepática. 2018; 6: 106–123.

3. Touma D., Sersté T., Ntounda R., Mulkay J.P., Buset M., Van Laethem Y. The liver involvement of the hydatid disease: a systematic review designed for the hepato-gastroenterologist. Acta Gastroenterol. Belg. 2013; 76 (2): 210–218.

4. Meeting of the WHO Informal Working Group on Echinococcosis (WHO-IWGE), Geneva, Switzerland, 15–16 December 2016. Geneva, Switzerland: World Health Organization; 2017 (WHO/ HTM/NTD/NZD/2017.01). Licence: CC BY-NC-SA 3.0 IGO.

5. Pascal G., Azoulay D., Belghiti J. Hydatid disease of the liver. In: Blumbgart's Surgery of the Liver, Biliary Tract, and Pancreas, 6th edition. 2017; 74: 1102–1121.

6. Farrokh D., Zandi B., Pezeshki Rad M., Tavakoli M. Hepatic alveolar echinococcosis. Arch. Iran Med. 2015; 18 (3): 199–202.

7. Shevchenko Yu.L., Nazyrov F.G., Akbarov М.М., Saydazimov Е.М., Sirojiddinov К.К. Modern aspects of surgery of the complicated liver echinococcosis. Bulletin of Pirogov National Medical & Surgical Center. 2018; 13 (4): 29–34. https://doi.org/10.25881/BPNMSC.2018.56.85.005 (In Russian)

8. Ramia J.M., Serrablo A., Seradilla M., Lopez-Marcano A., de la Plaza R., Palomares A. Major hepatectomies in liver cystic echinococcosis: a bi-centric experience. Retrospective cohort study. Int. J. Surg. 2018; 54 (Pt A): 182–186. https://doi.org/10.1016/j.ijsu.2018.04.049

9. Khan A., Zahoor S., Ahmed H., Malik U., Butt R.A., Muzam M.S., Kilinc S.G., Noor N., Zahoor S., Afzal M.S., Mansur H., Irum S., Simsek S. A retrospective analysis on the cystic Echinococcosis cases occured in Northeastern Punjab province, Pakistan. Korean J. Parasitol. 2018; 56 (4): 385–390. https://doi.org/10.3347/kjp.2018.56.4.385

10. Shevchenko Y.L., Nazirov F.G., Zainiddinov F.A., Hasan Özkan. Modern approaches to echinococcosis diagnosis and treatment. Bulletin of Pirogov National Medical & Surgical Center. 2020; 15 (1): 13–22. https://doi.org/10.25881/BPNMSC.2020.37.47.002 (In Russian)

11. Agudelo Higuita N.I., Brunetti E., McCloskey C. Cystic echinococcosis. J. Clin. Microbiol. 2016; 54 (3): 518–523. https://doi.org/10.1128/JCM.02420-15

12. Ferrer-Inaebnit E., Molina-Romero F.X., Segura-Sampedro J.J., González-Argenté X., Morón Canis J.M. A review of the diagnosis and management of liver hydatid cyst. Rev. Esp. Enferm. Dig. 2021 May 26. https://doi.org/10.17235/reed.2021.7896/2021

13. Solomon N., Fields P.J., Tamarozzi F., Brunetti E., Macpherson C.N.L. Expert reliability for the World Health Organization standardized ultrasound classification of cystic echinococcosis. Am. J. Trop. Med. Hyg. 2017; 96 (3): 686–691. https://doi.org/10.4269/ajtmh.16-0659

14. Kabaalioğlu A., Ceken K., Alimoglu E., Apaydin A. Percutaneous imaging-guided treatment of hydatid liver cysts: do long-term results make it a first choice? Eur. J. Radiol. 2006; 59 (1): 65–73. https://doi.org/10.1016/j.ejrad.2006.01.014

15. Özdil B., Keçe C., Ünalp Ö.V. An alternative method for percutaneous treatment of hydatid cysts: PAI technique. Turkiye Parazitol. Derg. 2016; 40 (2): 77–81. https://doi.org/10.5152/tpd.2016.4264

16. Fayyaz A., Ghani U.F. Successful treatment of hydatid cyst of lesser sac with PAIR therapy. J. Coll. Physicians Surg. Pak. 2013; 23 (12): 890–892. PMID: 24304995

17. Giorgio A., De Luca M., Gatti P., Ciraci' E., Montesarchio L., Santoro B., Di Sarno A., Coppola C., Giorgio V. Treatment of hydatid liver cyst with double percutaneous aspiration and ethanol injection under ultrasound guidance: 6.5-year median follow-up analysis. Cardiovasc. Intervent. Radiol. 2021; 44 (8): 1214–1222. https://doi.org/10.1007/s00270-021-02839-9

18. Bektasoglu H.K., Hasbahceci M., Tasci Y., Aydogdu I., Malya F.U., Kunduz E., Dolay K. Comparison of laparoscopic and conventional cystotomy/partial cystectomy in treatment of liver hydatidosis. Biomed. Res. Int. 2019; 2019: 1212404. https://doi.org/10.1155/2019/1212404.

19. Bostanci O., Kartal K., Yazici P., Karabay O., Battal M., Mihmanli M. Laparoscopic versus open surgery for hydatid disease of the liver. A single center experience. Ann. Ital. Chir. 2016; 87: 237–241.

20. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education; 2015. P. 1052–1056.