title: The laparoscopic approach to abdominal hydatid cysts: a prospective nonselective study using the isolated hypobaric technique.
abstract: OBJECTIVE
  The laparoscopic isolated hypobaric technique that we developed and use is safe and feasible for almost all kinds of hepatic and extrahepatic abdominal hydatid cysts.
  
  
  METHODS
  A case series.
  
  
  METHODS
  Between August 1992 and December 1999, 31 patients with no selection criteria underwent 32 consecutive laparoscopic operations for 52 symptomatic hydatid cysts located in the liver (49), spleen (1), and pelvis (2). Eleven patients underwent surgery for between 2 to 5 cysts.
  
  
  METHODS
  The main surgical maneuvers (puncture, parasite neutralization, and complete evacuation) were performed through an assembled transparent cannula, in which a vacuum was created, while its tip adhered firmly to the cyst wall. Following evacuation of the cyst contents, we attempted to perform partial pericystectomy, omentoplasty, and closed-suction drainage.
  
  
  METHODS
  Surgical complications and postoperative disease recurrence.
  
  
  RESULTS
  Mean cyst diameter was 8.4 cm (range, 3.5-25 cm). Seven cysts were subdiaphragmatic, and 6 were on the posterior (hidden) aspect of the liver. Mean postoperative follow-up was 49 months. Forty-one cysts contained live parasites, and 11 were secondarily infected. Twenty-four cysts were complex. Perioperative complications occurred in 5 patients, including 1 patient who died 1 month after surgery owing to Candida sepsis. Mean hospital stay was 6 days. No evidence of recurrence was recorded during follow-up.
  
  
  CONCLUSIONS
  The isolated hypobaric laparoscopic technique described provides a safe and efficacious approach to almost all types of abdominal hydatid cysts and takes advantage of the recognized benefits of the laparoscopic approach.
authors.affiliation: Department of Surgery, Western Galilee Hospital, PO Box 21, 22100 Nahariya, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Bickel
authors.forename: N
authors.initials: N
authors.lastname: Loberant
authors.forename: J
authors.initials: J
authors.lastname: Singer-Jordan
authors.forename: M
authors.initials: M
authors.lastname: Goldfeld
authors.forename: G
authors.initials: G
authors.lastname: Daud
authors.forename: A
authors.initials: A
authors.lastname: Eitan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004444:Echinococcosis, Hepatic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome