© Springer International Publishing Switzerland 2016
Abe Fingerhut, Ari Leppäniemi, Raul Coimbra, Andrew B. Peitzman, Thomas M. Scalea and Eric J. Voiglio (eds.)Emergency Surgery Course (ESC®) Manual10.1007/978-3-319-21338-5_1919. Emergency Surgery for Hydatid Cysts of the Liver
(1)
General Surgery, Head Department B-Charles Nicolle Hospital, University of Tunis, Tunis, Tunisia
(2)
Department of Surgical Research, Clinical Division for General Surgery, Medical University of Graz, Graz, Austria
(3)
Department of Surgical Oncology, Moscow Clinical Scientific Center, Moscow, Russia
19.1 General Notions
19.2 Goal of Management
19.3 Medical Treatment
19.4 Surgical Management
19.4.1 Surgical Approaches
19.4.2 Common Surgical Techniques
19.1 General Notions
Hydatid disease remains frequent in many regions in the world such as Mediterranean countries, Asia, and Central America.
Increasing travel has led to increased incidence in non-endemic areas.
Emergency surgery is reserved for complicated hydatid cysts of the liver, representing one out of five patients.
Rupture into the biliary tract with a large (>5 mm) bilio-cystic fistula (21–37 %), thoracic involvement (~2 %), rupture into the peritoneum (<2 %), vessels, and other organs (~1 %) represent the main complications. All these complications can be life threatening and call for immediate management.
Chapter aims to provide the appropriate management for each complication of liver hydatid cysts based on evidence-based surgery (level of evidence and grade of recommendation indicated whenever appropriate).
19.2 Goal of Management
To control the infection process, evacuate the contents of the cyst, and prevent recurrence
19.3 Medical Treatment
Appropriate antibiotics are mandatory to stop progression of infection.
Adapted resuscitative measures.
Control of metabolic disorders (e.g. diabetes mellitus).
Postoperative antihelminthic drug treatment is mandatory for most authors: albendazole (10 mg per kg and per day) for 3 months, and especially after treatment of large biliocystic fistula (level IV; grade C).
19.4 Surgical Management
19.4.1 Surgical Approaches
Laparotomy is the standard approach: right subcostal incision prolonged if necessary to the left.
Laparoscopy may be considered in selected cases.
19.4.2 Common Surgical Techniques
Removal of the cyst is usually described as “pericystectomy.”
“Closed total pericystectomy” removes the cyst without opening it.
“Open total pericystectomy” sterilizes the contents with antiscolicidal agents, evacuates the contents of the cyst, then removes the pericystic tissue.Related posts:
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