Laparoscopic treatment of echinococcal cysts of the liver

Even though echinococcal cysts have been cured by puncture and instillation of scolicidal medications, surgery is still the mainstay of the treatment of hydatid disease. The aim of the surgical treatment is the elimination of scolices, the removal of all viable parts of the cyst and the obliteration of the remaining cavity. This can be achieved by resective procedures, but also by a more conservative approach with drainage and obliteration of the cyst. The latter procedure can be done by open surgery or laparoscopically . The disadvantages of the laparoscopic approach are the increased danger o f contamination of the abdominal cavity with scolices and difficulties to a spirate a highly viscous cyst content. Furthermore, cysts which are located deep in the parenchyma of the liver should not be approached laparoscopica lly because of the significant danger of hemorrhage. The advantage of the l aparoscopic approach in selected cysts, i. e. those which are located super ficially and having a liquid content, are a shorter hospital stay, lower in cidence of wound infection and the ability of the surgeon to inspect the in side of the cyst more thoroughly and rule out daughter cysts and connection s to the biliary tract. A review of the literature (Iz 76) indicates that i n most laparoscopically treated hydatid cysts of the liver a simple drinage (59 %) or an unroofing (31 %) is performed. The complication rate is 21 %. Because there are no longterm observations after laparoscopic operations f or hydatid disease the question of recurrence cannot yet be answered.