Laparoscopic and open operations in the treatment of hepatic echinococcosis. Analysis of short- and long-term results

Aim: to evaluate the short- and long-term outcomes of laparoscopic and open operations in the treatment of hepatic echinococcosis.

Materials and methods. The results of laparoscopic and open echinococcectomies performed from 2013 to 2020 were retrospectively studied. Laparoscopic operations were considered the method of choice. Open operations were performed in cases with contraindications to the laparoscopic approach.

Results. In total, 57 patients were operated: 47 laparoscopically (including robotic approach in 4 cases), 9 patients underwent open surgery. Radical procedures prevailed among laparoscopic cystectomies: 46 (98%). In the groups of laparoscopic/open cystectomies, partial pericystectomy was performed in 1/3 of patients, subtotal – in 24/4, total – in 13/0, and liver resection – in 9/2 patients, respectively. Laparoscopic procedures were performed mainly for types 1 and 3 of cysts, open procedures – for type 2 (WHO), recurrent and extrahepatic abdominal cysts were indication for open surgery. The frequency of severe complications did not differ between the groups. In the laparoscopic group, 1 (2%) patient died. After laparoscopic cystectomies, the mean (median) hospital stay (8 vs 10 days) and duration of abdominal drainage (10 vs 12 days) were significantly shorter. Relapse occurred only after conservative cystectomies, in one patient in each group.

Conclusion. Laparoscopic radical surgery for liver hydatid cysts may be the method of choice if performed in a specialized HPB center. Patient selection criteria should be based on the center's experience in laparoscopic liver surgery.

1. 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

2. Jabbari Nooghabi A., Mehrabi Bahar M., Asadi M., Jabbari Nooghabi M., Jangjoo A. Evaluation and comparison of the early outcomes of open and laparoscopic surgery of liver hydatid cyst. Surg. Laparosc. Endosc. Percutan. Tech. 2015; 25 (5): 403– 407. https://doi.org/10.1097/SLE.0000000000000199

3. Tuxun T., Zhang J.H., Zhao J.M., Tai Q.W., Abudurexti M., Ma H.Z., Wen H. World review of laparoscopic treatment of liver cystic echinococcosis – 914 patients. Int. J. Infect. Dis. 2014; 24: 43–50. https://doi.org/10.1016/j.ijid.2014.01.012

4. Pang Q., Jin H., Man Z., Wang Y., Yang S., Li Z., Lu Y., Liu H., Zhou L. Radical versus conservative surgical treatment of liver hydatid cysts: a meta-analysis. Front. Med. 2018; 12 (3): 350– 359. https://doi.org/10.1007/s11684-017-0559-y

5. Ibrahim I., Tuerdi M., Zou X., Wu Y., Yasen A., Abihan Y., Xu Q., Balati M., Zhao J., Li T., Tuxun T. Laparoscopic versus open surgery for hepatic cystic echinococcosis: a systematic review and meta-analysis. Int. J. Clin. Exp. Med. 2017; 10 (12): 16788–16797.

6. Jarufe N., Galindo J.L., Bächler J.P., Ahumada V., Rebolledo R., Crovari F., Guerra J.F., Martínez J. Radical laparoscopic treatment for hepatic hydatid disease. J. Gastrointest. Dig. Syst. 2016; 6: 419. https://doi.org/10.4172/2161-069X.1000419

7. 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

8. Go Wakabayashi. What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection? Hepatobiliary Surg. Nutr. 2016; 5 (4): 281–289. https://doi.org/10.21037/hbsn.2016.03.03

9. Kawaguchi Y., Tanaka S., Fuks D., Kanazawa A., Takeda Y., Hirokawa F., Nitta H., Nakajima T., Kaizu T., Kaibori M., Kojima T., Otsuka Y., Kubo S., Hasegawa K., Kokudo N., Kaneko H., Wakabayashi G., Gayet B. Validation and performance of three-level procedure-based classification for laparoscopic liver resection Surg. Endosc. 2020; 34 (5): 2056– 2066. https://doi.org/10.1007/s00464-019-06986-6.

10. Vishnevsky V.A., Ikramov R.Z., Kakharov M.A., Yefanov M.G. Radical treatment of liver echinococcosis. State of art. Bulletin of Siberian Medicine. 2007; 6 (3): 22–26. https://doi.org/10.20538/1682-0363-2007-3-22-26 (In Russian)

11. Yüksel O., Akyürek N., Sahin T., Salman B., Azili C., Bostanci H. Efficacy of radical surgery in preventing early local recurrence and cavity-related complications in hydatic liver disease. J. Gastrointest. Surg. 2008; 12 (3): 483–489. https://doi.org/10.1007/s11605-007-0301-1

12. Palanivelu C., Jani K., Malladi V., Senthilkumar R., Rajan P.S., Sendhilkumar K., Parthasarthi R., Kavalakat A. Laparoscopic management of hepatic hydatid disease. JSLS. 2006; 10 (1): 56–62. PMID: 16709359, PMCID: PMC3015664

13. Misra M.C., Khan R.N., Bansal V.K., Jindal V., Kumar S., Noba A.L., Panwar R., Kumar A. Laparoscopic pericystectomy for hydatid cyst of the liver. Surg. Laparosc. Endosc. Percutan Tech. 2010; 20 (1): 24–26. https://doi.org/10.1097/SLE.0b013e3181cdf3c4

14. Ramia J.M., Poves I., Castellón C., Diez-Valladares L., Loinaz C., Serrablo A., Suarez M.A. Radical laparoscopic treatment for liver hydatidosis. World J. Surg. 2013; 37 (10): 2387–2392. https://doi.org/10.1007/s00268-013-2150-2

15. Efanov M., Azizzoda Z., Elizarova N., Alikhanov R., Karimkhon K., Melekhina O., Kulezneva Y., Kazakov I., Vankovich A., Chitadze A., Salimgereeva D., Tsvirkun V. Laparoscopic radical and conservative surgery for hydatid liver echinococcosis: PSM based comparative analysis of immediate and long-term outcomes. Surg. Endosc. 2021; 1. https://doi.org/10.1007/s00464-021-08391-4

16. Tuxun T., Aji T., Tai Q.W., Zhang J.H., Zhao J.M., Cao J., Li T., Shao Y.M., Abudurexiti M., Ma H.Z., Wen H. Conventional versus laparoscopic surgery for hepatic hydatidosis: a 6-year singlecenter experience. J. Gastrointest. Surg. 2014; 18 (6): 1155–1160. https://doi.org/10.1007/s11605-014-2494-4

17. Joshi U., Subedi R., Jayswal A., Agrawal V. Clinical characteristics and management of the hydatid cyst of the liver: a study from a tertiary care center in Nepal. J. Parasitol. Res. 2020; 9: 8867744. https://doi.org/10.1155/2020/8867744

18. Zaouche A., Haouet K., Jouini M., El Hachaichi A., Dziri C. Tunisian Surgical Association. Management of liver hydatid cysts with a large biliocystic fistula: multicenter retrospective study. World J. Surg. 2001; 25 (1): 28–39. https://doi.org/10.1007/s002680020005

19. Sokouti M., Sadeghi R., Pashazadeh S., Abadi S.E.H., Sokouti M., Ghojazadeh M., Sokouti B. A systematic review and meta-analysis on the treatment of liver hydatid cyst using meta-MUMS tool: comparing PAIR and laparoscopic procedures. Arch. Med. Sci. 2019; 15 (2): 284–308. https://doi.org/10.5114/aoms.2018.73344