Materials and Methods Between January 2014 and June 2017, 88 patients
diagnosed with hepatic hydatid cyst were admitted and
treated at the General Surgery Clinic of the “Colentina”
Hospital in Bucharest. The following parameters were taken
into consideration: age, gender, place of origin, year and
duration of admission, symptoms and signs at admission,
serological and paraclinical investigations relevant to liver
function and E. granulosus infection, the performed imaging
investigations and their results, the received treatment and
post-treatment evolution and complications.
Of the total number of patients enrolled in the study,
50 were female and 38 male. The age groups with the
most representatives were 30-39 years and 40-49 years.
The number of female patients was higher in the 30-39
and 40-49 age groups. Over half of the female patients
liver without communicating with the biliary tree [11].
They can also be attempted in the case of multiple cysts
(but fewer than three). The types of interventions that
may be performed by laparoscopy are pericystotomy
with cystectomy, partial or total pericystectomy, hepatic
segmentectomy. It should be specified that laparoscopic liver
resections are practiced with restrain, although mortality
is around 1% [13]. During laparoscopic interventions,
there is a higher risk of intraperitoneal hydatid fluid loss
with the occurrence of secondary hydatidosis [9]. Haito
et al. recommend that conservative operations should be
performed laparoscopically, such as endocystectomy or
total cystectomy, that allow the dissection at the level of
the pericyst. He concludes that laparoscopic intervention
is easier in small cysts (less than 6 cm) with superficial
localization and in a more advanced stage of development
[14]. The contraindications of laparoscopy are cyst rupture
in the biliary tree, central cyst localization, cystic dimensions
over 15 cm, thickened or calcified cystic walls [9].
The interventional endoscopy includes stenting
on the main bile duct, Endoscopic Retrograd
Cholangiopancreatography (ERCP), endoscopic
sphincterotomy.
The minimally invasive techniques used in hepatic
hydatid cyst treatment are PAIR, PAIRD, Modified
Catheterisation Technique (MoCaT) or Percutaneous
Evacuation (PEVAC). The PAIR technique (puncture,
aspiration, injection of 95% ethanol solution or hypertonic
saline solution, re-aspiration) is applicable to the hepatic
hydatid cyst in stages CE1, CE2, CE3. The indications
are: cyst with daughter vesicles +/-, detached proligere
membrane, multiple cysts if accessible to puncture,
superinfected cyst, patients refusing surgery, post-surgical
relapse, patients with a surgical contraindication, patients not
responding to drug therapy, pregnancy. Contraindications:
non-cooperative patients, cysts that can not be punctured,