Z Gastroenterol 2019; 57(01): e28
DOI: 10.1055/s-0038-1677113
2. Clinical Hepatology, Surgery, LTX
Georg Thieme Verlag KG Stuttgart · New York

Endocystectomy technique for surgical treatment of hepatic cystic echinococcosis

M Al-Saeedi
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
E Khajeh
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
O Ghamar Nejad
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
K Hoffmann
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
M Stojkovic
2   Section of Clinical Tropical Medicine, University Hospital Heidelberg, Heidelberg, Germany
,
T Weber
3   Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
,
T Junghanss
2   Section of Clinical Tropical Medicine, University Hospital Heidelberg, Heidelberg, Germany
,
MW Büchler
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
A Mehrabi
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
› Author Affiliations
Further Information

Publication History

Publication Date:
04 January 2019 (online)

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Background:

There are currently four possible treatments for cystic echinococcosis (CE): surgery, percutaneous treatment, medical treatment (benzimidazoles), and watch-and-wait. Treatment is decided based on WHO cyst staging. The surgical techniques employed depend on the cyst location and complications presented, e.g. cyst-biliary fistulas, rupture, and secondary bacterial infection. The two principal approaches are radical (resection of the cyst) and conservative (evacuation of the cyst content and partial removal of the cyst capsule). Here, we present a standardized conservative approach, the endocystectomy, which is suitable for surgical trainees.

Materials and methods:

Between 2011 and 2017, 21 patients (12 men and nine women with a median age of 28 years) with hepatic CE that underwent endocystectomy were retrospectively evaluated and details of the endocystectomy procedures were described. Before the operation and during the follow-up period (median duration of 17 months), patients underwent sonography and/or magnetic resonance imaging during regular visits that were managed by an interdisciplinary team.

Results:

Forty-seven cysts were treated by endocystectomy and the median number of cysts per patient was two (range: 1 – 8). Nine patients (43%) had a single cystic lesion. The median operation time was 165 minutes (range: 120 – 250 minutes) and the median intraoperative bleeding volume was 200 mL (range: 50 – 800 mL). The median hospital stay was nine days (range: 6 – 28 days). Morbidity (Clavien-Dindo III) occurred in four patients (19%). The bile leakage rate was 6.4% per cyst. No mortality and no recurrence were reported during the median follow-up of 17 months (range: 1 – 75 months).

Conclusions:

The standardized endocystectomy method we present is a safe procedure with acceptable morbidity, no mortality, and without relapse in our patient series. Important elements of our approach are interdisciplinary management, adequate diagnostic work-ups, and regular pre- and postoperative visits.