Open or laparoscopic treatment for hydatid disease of the liver? A 10-year single-institution experience.
BACKGROUND
Selection of the most appropriate treatment to obtain the lowest morbidity, mortality, and recurrence rates is mandatory for hydatid disease of the liver. This study evaluated the results of laparoscopic treatment (compared with the open approach) in the context of a 10-year single-institution experience.


METHODS
Between January 1998 and January 2008, 333 patients with hydatid disease of the liver underwent surgery in the authors' department. Only the following aspects were considered as selection criteria for laparoscopic surgery: liver cyst not located in segment 1 or 7, with corticalization on the surface and no evidence of intrabiliary rupture. Of 62 patients who underwent laparoscopic treatment, 3 required conversion to open surgery. The remaining 59 patients (group 1) were analyzed. During the same period, 271 patients with hepatic hydatid disease underwent conventional surgery, but only 172 records were compatible with the criteria for the laparoscopic approach and the respective patients were retrospectively reviewed (group 2).


RESULTS
Conversion to open surgery occurred in three cases (4.84 %). The mean cyst diameter was 6.62 cm (range, 2-15 cm) in group 1 and 7.23 cm (range, 2-18 cm) in group 2 (p = 0.699). The mean operative time was 72 min (range, 45-140 min) in group 1 and 65 min (range, 35-120 min) in group 2 (p < 0.001). The general complication rate and abdominal wound complication rate were respectively 0 % and 0 % in group 1 (p = 0.023) compared with 5.23 and 8.72 % in group 2 (p = 0.015). The mean hospital stay was 6.42 days (range, 1-21 days) in group 1 and 11.7 days (range, 4-80 days) in group 2 (p < 0.001). The mean follow-up period was 24.2 months (range, 6-32 months) in group 1 and 28.4 months (range, 6-40 months) in group 2. No recurrences were observed in either group during this period.


CONCLUSIONS
Laparoscopic surgery provides a safe and efficacious approach for almost all types of hepatic hydatid cysts. Large, prospective, randomized trials are needed to confirm its superiority.
Department of Surgery, Iuliu Hatieganu, University of Medicine and Pharmacy, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 19-21 Croitorilor Street, 400162, Cluj-Napoca, Romania. florinzaharie@yahoo.com
Florin
F
Zaharie
Dana
D
Bartos
Lucian
L
Mocan
Roxana
R
Zaharie
Cornel
C
Iancu
Claudiu
C
Tomus
D000368:Aged; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D004444:Echinococcosis, Hepatic / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D016896:Treatment Outcome