Gasless vs gaseous laparoscopy in the treatment of hepatic hydatid disease

Background: Despite the reduced rate of occurrence, the hydatidosis of the liver is still taking an important place in surgical practice in Asia Minor and the Middle East. Traditional techniques for performing liver cyst surg ery seem to be comparatively traumatic. In this clinical study, we present our experience with laparoscopic treatment of hydatid cyst of the liver and discuss the validity of the gasless technique as a solution to carbon diox ide (CO2) ensufflation problems. Methods: All patients were prepared by administrating albendazole for 21 da ys preoperatively. Surgery was per formed on 87 patients under general anes thesia. Working space was obtained in 51 operations by using an abdominal w all lifting device, Laparolift(TM) (Origin Med Systems, Menlo Park, Califor nia, USA) (group 1). In 36 patients, the abdominal cavity was insufflated w ith CO2 gas (group 2). In all cases, hydatid cysts were identified, and gau ses soaked in germicide solution were placed around them. The cysts were pu nctured and aspirated. Then germisid solution was injected into the cysts. The cysts walls were opened, and germinative membranes were evacuated. Results. The median operation time was 50.49 +/- 10.9 min (range, 30-75 min ) in group 1 and 70.8 +/- 16 min (ranges 40-120 min) in group 2. The differ ence in the operative times of the two groups was significant (p < 0.01). T here was no significant difference between the minor complications of the t wo groups. There were no deaths and no major complications or conversions t o open surgery in any of the groups. There were no recurrences during follo w-up time. Conclusions: The use of gasless technique for the laparoscopic treatment of liver cyst is a safe, time-saving, and promising procedure that can be app lied in selected cases.