Laparoscopic endocystectomy in patients with liver echinococcosis

Abstract

Aim. To evaluate the efficiency and to review the indications for laparoscopic endocystectomy in liver echinococcosis.Methods. The results of laparoscopic endocystectomy in 86 patients treated for liver echinococcosis compared to cystectomy by laparotomy in 159 patients are presented.Results. Optimal characteristics for laparoscopic endocystectomy were types CL, CE1-CE3 of cystic echinococcosis according to cystic echinococcosis ultrasonic classification by H.A. Gharbi (1981) modified by World Health Organization (2003) with cysts localized in 2-6 liver segments; partial superficial location of cysts; cyst size not less than 5 cm; no cysts in 1, 7 and 8 liver segments or deeply located cysts of any size, as well as cysts of CE4-CE5 types. Of the 86 cases in which laparoscopic endocystectomy was completed successfully, in 4 patients the surgery was continued by a laparotomy access. The reasons for the continuation with laparotomy were unsuccessful attempts for stable hemostasis at resection of liver fibrous capsule excesses (1 case), presence of large fistula between the cyst and components of the biliary system at the bottom of the fibrous cavity (2 patients), and location of the second cyst in the segment unavailable for laparoscopic manipulation (1 case). The frequency of early complications after laparoscopic endocystectomy was 15.1% (p=0.23). Relapse occurred in 1 (1.2%) patient (p=0.23). Comparative assessment of echinococcosis recurrence risk in different periods (Kaplan-Meier analysis) after laparoscopic interventions and laparotomy, both followed by albendazole treatment, did not identify any statistically significant differences.Conclusion. The early and long-term effects of laparoscopic endocystectomy in liver echinococcosis are not inferior to conventional laparotomy if indications are strictly followed.