Diagnosis and surgical treatment of liver echinococcosis

V.O. Shaprinskyi; O.O. Vorovskyi; O.A. Kaminskyi; Ya.M.  Pashynskyi

doi:10.26641/2307-0404.2021.4.248172

Authors

V.O. Shaprinskyi National Pirogov Memorial Medical University, Vinnytsya Pirogova str., 56, Vinnytsya, 21018, Ukraine https://orcid.org/0000-0002-3890-6217
O.O. Vorovskyi National Pirogov Memorial Medical University, Vinnytsya Pirogova str., 56, Vinnytsya, 21018, Ukraine https://orcid.org/0000-0002-8933-3965
O.A. Kaminskyi National Pirogov Memorial Medical University, Vinnytsya Pirogova str., 56, Vinnytsya, 21018, Ukraine https://orcid.org/0000-0002-7753-6933
Ya.M. Pashynskyi National Pirogov Memorial Medical University, Vinnytsya, Pirogova str., 56, Vinnytsya, 21018, Ukraine https://orcid.org/0000-0002-3001-9955

DOI:

https://doi.org/10.26641/2307-0404.2021.4.248172

Keywords:

echinococcosis, liver, echinococetctomy, pericystectomy

Abstract

The results of treatment of 72 patients with echinococcosis of the liver were analyzed, women – 62 (86.2%), men – 10 (13.8%). Primary echinococcosis was detected in 69 (95.8%) patients, secondary – in 3 (4.2%). Among instrumental research methods, ultrasound and computed tomography examination were of diagnostic value. Single liver cysts were found in 63 (87.5%) patients, multiple – in 9 (12.5%). Among patients with solitary cysts, the right lobe was more often affected than the left – 48 (66.7%) vs 24 (33.3%) cases. Echinococcosis of central localization was less common and was noted in 8 (11.1%) cases. Echinococcosis complications were observed in 16 (22.2%) patients. Among them, most often there were suppurations of the cyst – in 13 (18.1%); a bursting of the cyst into the free abdominal cavity – in 1 (1.4%), in the pleural cavity – 1 (1.4%), in the biliary tract – in 1 (1.4%). Partial or complete liming of the hand was observed in 12 (16.7%) patients. In 20 (27.8%) cases, the operation was performed from the upper median access, in 42 (58.3%) – from oblique hypochondria accesses by Kocher or by Fedorov. Pericystectomy was performed in 48 (66.7%) patients, in 8 (11.1%) patients underwent resections of liver segments with an echinococcal cyst, in 4 (5.6%) – cyst opening with removal of contents and treatment of its cavity. Laparoscopic echinococectomy was used in 12 (16.7%) patients. In the postoperative period complications were observed in 16 (22.2%) patients. The use of the welding electrocoagulator EK-300M "Swarmed" in the thermal rehabilitation of the walls of the residual cavity after echinococectomy allowed to reduce blood loss from 2200±210 ml to 250±50 ml. With the use of laparoscopic echinococectomy, intraoperative blood loss was reduced by 9 times (р=0.0001); duration of operation – 2 times (р<0.05), stay in hospital – 3.3 times (р=0.002). There were no fatal outcomes. Before and after operation antirelapse antiparasitic therapy with albendazole (Vormil) was performed in two cycles of 28 days, separated by a 14-day break. The dose at body weight over 60 kg was 400 mg 2 times a day, and for less than 60 kg the drug was calculated at a rate of 15 mg/kg/day. There were 2 (2.8%) cases of relapse, there was no mortality.

References

Bodnya EI. [Optimization of the diagnostic algorithm in patients with liver echinococcosis]. Gepatologiya. 2018;4:20-37. Russian.

Vetshev PS, Musaev GKh, Fatyanova AS. [Echi¬nococcosis: the basics of diagnosis and the role of minimally invasive technologies (literature review)]. Annaly khirurgicheskoi gepatologii. 2018;20(3):47-53. Russian.

doi: https://doi.org/10.16931/1995-5464.2015347-53

Kalmykov EL, Gulov MK, Kapustin BB, Mukhabbatov DK, Nematzoda O, Zardakov SM, Kadyrov AR. [To the question of mini-invasive surgery of liver echinococcosis]. Novosti khirurgii. 2019;27(5):563-73. Russian. doi: https://doi.org/10.18484/2305-0047.2019.5.563

Kirtanasov IP, Ivshin VG. [Percutaneous interventions in the treatment of patients with multichamber hydatid echinococcosis of the liver]. Vestnik novykh meditsinskikh tekhnologiy. Elektronnoe izdanie. 2019;13(2):23-32. Russian. doi: https://doi.org/10.18484/2305-0047.2019.5.563

Shamsiev AM, Shamsiev JA, Kurbaniyazitov ZB, Rakhmanov KE, Davlatov SS. [Echinococcosis of the liver: frequency of occurrence, pathogenesis, classification, diagnosis and treatment (literature review)]. Klinichna ta eksperimentalna patologiya. 2018;17;3(65):126-33. Russian.

doi: https://doi.org/10.24061/1727-4338.XVII.3.65.2018.145

Axrorovich SU, Israfulovich RM, Isomiddinovich M, Yakhshiboevich SZ. Surgical tactics in liver echinococcosis of subphrenic localization. European science review. 2018:212-3.

Bayrak M, Altintas Y. Current approaches in the surgical treatment of liver hydatid disease: single center experience. BMC Surg. 2019;95:1054. doi: https://doi.org/10.1186/s12893-019-0553-1

Paternoster G, Boo G, Wang C, et al. Epidemic cystic and alveolar echinococcosis in Kyrgyzstan: an analysis of national surveillance data. The Lancet Global Health. 2020;8(4):e603-e611. doi: https://doi.org/10.1016/s2214-109x(20)30038-3

Ito A, Nakao M, Lavikainen A, Hoberg E. Cystic echinococcosis: Future perspectives of molecular epide¬miology. Acta tropica. 2017;165:3-9. doi: https://doi.org/10.1016/j.actatropica.2016.05.013

Іvanov SA, Kenarskaya MV, Panfilov KA. Liver hydatidosis: optimization of surgical treatment methods. Science and Innovations in Medicine. 2018;4:20-26.

Nasritdinovich US, Alisherovich UK, Qizi YDB, Qizi TYM. Comprehensive diagnosis of liver echino¬coccosis (literature review). Вопросы науки и обра¬зования. 2019;2(45):95-102. Available from: https://cyberleninka.ru/article/n/comprehensive-diagnosis-of-liver-echinococcosis-literature-review/viewer

Tetali B, Grahf DC, Abou Asala ED, Axelson D. An Atypical Presentation of Cystic Echinococcosis. Clinical Practice and Cases in Emergency Medicine. 2020:1-3. doi: https://doi.org/10.5811/cpcem.2020.1.45842