The laparoscopic approach to abdominal hydatid cysts - A prospective nonselective study using the isolated hypobaric technique

Hypothesis: The laparoscopic isolated hypobaric technique that we developed and use is safe and feasible for almost all kinds of hepatic and extrahepa tic abdominal hydatid cysts. Design: A case series. Patients: Between August 1992 and December 1999, 31 patients with no select ion criteria underwent 32 consecutive laparoscopic operations for 52 sympto matic hydatid cysts located in the liver (49), spleen (1), and pelvis (2). Eleven patients underwent surgery for between 2 to 5 cysts. Interventions: The main surgical maneuvers (puncture, parasite neutralizati on, and complete evacuation) were performed through an assembled transparen t cannula, in which a vacuum was created, while its tip adhered firmly to t he cyst wall. Following evacuation of the cyst contents, we attempted to pe rform partial pericystectomy, omentoplasty, and closed-suction drainage. Main Outcome Measures: Surgical complications and postoperative disease rec urrence. Results: Mean cyst diameter was 8.4 cm (range, 3.5-25 cm). Seven cysts were subdiaphragmatic, and 6 were on the posterior (hidden) aspect of the liver . Mean postoperative follow-up was 49 months. Ferry-one cysts contained liv e parasites, and 11 were secondarily infected. Twenty-four cysts were compl ex. Perioperative complications occurred in 5 patients, including 1 patient who died 1 month after surgery owing to Candida sepsis. Mean hospital stay was 6 days. No evidence of recurrence was recorded during follow-up. Conclusions: The isolated hypobaric laparoscopic technique described provid es a safe and efficacious approach to almost all types of abdominal hydatid cysts and takes advantage of the recognized benefits of the laparoscopic a pproach.