Presentation China-hydatid _mpeg

8/8/2019 Presentation China-hydatid _mpeg

1/16


2/16

Our attempt may fail, but wemust never fail to make an

attempt.

One can conquer almost any fear if you will

make up your mind to do so.So I attempted my first Laparoscopic

Hydatid cystectomy with Omentoplasty in

low resource settings.


3/16

Hydatidosis caused by Echinococcus

Granulosus is endemic parasitic disease in

Mediterranean countries, some parts ofNorthern china and some parts of Indian

subcontinent.

Dogs are definitive hosts and sheep asintermediate hosts, Humans are accidental

intermediate hosts .Once within humans,

ingested eggs hatch in duodenum to release

oncospheres ( Larvae ) which burrow into thejejunal submucosa and enter the veins or

lymphatics to reach liver which acts as an

effective filter for most of the Larvae.


4/16

However there may be other sites also involved .These are:

ORGAN PERCENTAGE

Liver 55-75

Lungs 18-35Peritoneal cavity 10-16

Kidneys 1-4

Spleen 2-3

Uterus & Adnexa 0.5-1.5

Retroperitoneum 0.5-1.5

Pancreas 0.3-0.8


5/16

Asymptomatic

Hepatomegaly Jaundice

Urticaria

Malaise

Abdominal PainAbdominal Mass

Fever

Anorexia

Cough

Clinical features of Hepatic Hydatid disease:


6/16

Investigations:

3) Imaging studies ---

Plain X-ray abdomen --- may show elevated right hemi-diaphragm

Ultrasonography--- due to its easy availability and affordability and itsdiagnostic sensitivity, it is the imaging test of choice.

CT scan--- This gives the maximum information of the position and extent

of the hydatid disease.

MRI -- however it does not yield any extra information as compared to CT.

1) Routine Hematology ---- which may show elevated total leucocytes, and

eosinophia

2) Casonis Test --- However obsolete due to its low specificity & sensitivity and

also due to its risk of anaphylaxis.


7/16

IHA- Indirect Haemagglutination testCFT-complement fixation test

LT-Latex agglutination test

IEP-Immunoelectrophoresis

ELISA- Enzyme linked immunosorbent assay

BDT-Basophil degranulation test.

The strategy for serological diagnosis should be initial screening with

highly sensitive tests like IHA or LT followed by confirmation by highly

specific tests like ELISA.

while CFT has a role in monitoring progress after surgical treatment as

it turns negative within 12 months of cure.

Recently there are reports that BDT has high sensitivity and it

becomes negative within a week of cure .

4) Various Immunological tests


8/16

1) Rupture---

Intraperitoneal

Intra-Biliary

Intrapleural

Intrabronchial

Intra adjacent organs

2) Pressure effects like obstructive jaundice.

3) Cholangitis, biliary cirrhosis.

4) Secondary infection.

5) Allergic reaction---

Urticaria

Bronchospasm

Anaphylaxis

Eosinophilia

Complications of Hepatic Hydatid Cysts.


9/16

1) Medical - Albendazole,

2) PAIR - Puncture Aspiration Injection , Re-aspiration.

This was proposed in 1986 by a Tunisean team.

3) Surgery - Open or Laparoscopic.

Surgery remains the mainstay of treatment for Hepatic Hydatid disease,which may be

Marsupilization

Total pericystectomy

Partial Pericystectomy Partial Pericytectomy with Omentoplasty

Liver resections.

The First laparoscopic treatment for Hydatid cyst of liver was published

in 1994 by Bichel et al.

Treatment:


10/16

Here in our patient we gave albendazole pre-operatvely, 10

mg/kg body weight for 2 weeks before surgery.

Position of patient was supine with Left lateral tilt with Sandbag

under the patient on Right side.

10 mm camera port at umbilicus by open technique,pneumoperitoneum achieved, rest all working ports under vision,

10 mm epigastric, 5 mm Right mid-clavicular , 5 mm Left

subcostal region.

Cyst identified, adhesions gently separated and cyst surfaceexposed.

Penetration of cyst wall with trocar, aspiration of contents done.


11/16

Cavity washed with Normal saline and Hypertonic saline.

Once the returning fluid is clear , the telescope is introduced

in the cyst cavity to visualize the interior for any cyst-biliary

communication , which was not there.

Telescope is then taken out , washed thoroughly and cleanedbefore reintroduction in peritoneal cavity.

All the laminated membranes carefully removed, omentum

taken into the cavity and sutured with cavity edges.

Post-operatively patient was followed up every month and is

now symptomless past six months.


12/16


13/16


14/16


15/16

Laparoscopic treatment of hepatic hydatid cyst should not beregarded as a new technique rather it is new and minimally

invasive access to perform established surgical technique and

it follows the basic surgical principles of treating hydatid cyst,

which are evacuation of cyst contents, prevention of spillage,sterilization of cavity with scolicidal agents and management of

the residual cavity.

Hence, Laparoscopic treatment for Liver Hydatid Cyst is safe

and effective in selected patients and offer all the advantage of

minimal invasive surgery with low morbity and early recovery.

Conclusion


16/16

Presentation China-hydatid _mpeg

Documents

Transcript of Presentation China-hydatid _mpeg