Cystic hydatic disease (echinococcosis) of the liver is a disease affecting usually the liver. However, it may occur in the lung as well as in other organs and is caused by a parasite (Echinococcus granulosus). Cysts typically affect the liver and they may cause serious complications, this is why surgical treatment is recommended most of the times. Laparoscopic surgery plays a determining part.
Echinococcus is a parasite found normally in the small intestine of the canids and is transmitted to humans through vegetables and fruits infested by the parasite’s larva from canine feces. When humans ingest food contaminated with the parasite larva, these pass to the intestine and then echinococcus passes into the bloodstream (portal circulation) ending at the liver. The cyst has some particular features and is formed by two layers, the fibrous cyst and the mother cyst. It contains fluid and possibly smaller (daughter) cysts.
Clinical image:
Typically, no symptoms occur unless pressure symptoms are present involving adjacent organs or some complication. Possible complications include suppuration and rupture of the cyst into the abdominal cavity, the biliaries, the alveoli, and elsewhere that present with pain, fever, jaundice, cough, severe allergic reaction etc.
Diagnosis:
Ultrasound, CT scan, serological testing detecting anti-echinococcal antibodies.
Treatment:
Echinoccociasis is mainly treated surgically. It consists in cyst de-roofing and even more radical surgical operations such as removing the entire cyst with its capsule, hepatecomy, etc. These surgical procedures are currently performed laparoscopically with excellent results. Special attention is given to isolating the operating field to avoid any fluid leakage into the peritoneal cavity. The usual technique applied consists initially in aspirating fluid, infusing the protocollicidal agent, and removing the capsule by preserving or not its intrahepatic part. The resulting gap is subsequently covered using a special technique. En block cystectomy may result in bile fluid spillage from the hepatic parenchyma. The laparoscopic approach enables surgeons to better view and access the minuscule biliaries that are responsible for this complication in therefore averting it with adequate sutures.
Calcified small cysts present on the liver wall that are serologically negative do not need to be treated, while the adjuvent medication has also an important part to play, pre and post operatively, with the use of special agents like albendazole.
The first laparascopic resection of a large hydatid cyst in Greece was successfully performed at Evangelismos Hospital in Athens, in 2014. It was performed on an 82 year old woman presenting a cyst on the right hepatic lobe totaling 19×14 cm. The surgical procedure was performed very successfully with no postoperative complications.