Akademik Veri Yönetim Sistemi
11TH NATIONAL AND 4TH INTERNATIONAL CONGRESS OF HYDATIDOLOGY, 2-4 October 2024, Edirne/TURKEY, Edirne, Türkiye, 2 - 04 Ekim 2024, ss.62-65
Thoracic surgeons are not infrequently asked for the management of hydatid cysts located at the upper part subdiaphragmatic location of the liver. Thoracotomy provides better exploration and access to cysts located in this area when compared to laparotomy. The surgical approach is determined depending on whether the cyst is intact or ruptured, single or multiple, unilateral or bilateral or together with a liver dome cyst, the size of the cyst and associated destruction of lung parenchyma(1). The principle of the resection of liver cysts; similar to pulmonary cysts; however, there are important technical differences between the two operations: Hepatic cysts contain daughter vesicles more commonly than pulmonary cysts for this reason, a scolocidal agent to kill the parasite such as hypertonic saline solution or 10% povidone iodine must be injected through the diaphragm into the cyst to prevent the spreading of living vesicles in the abdomen or thorax. This must be done before the opening and removal of the cyst. Diaphragm is cut using scissors and its muscle is separated from the cyst by blunt and sharp dissections with no pressure over the cyst, when the intra cystic pressure has been lowered, the cyst is opened from the upper most part of the cyst and its contents are aspirated with a large-holed suction device. The cyst contains numerous daughter vesicles that it is not technically possible to aspirate with a suction device or take out with a grasper. So, after the diaphragm is incised enough to evacuate the cyst completely, the fluid containing daughter vesicles is removed with a sterile spoon. The cavity remaining between the upper surface of the liver and the fibrous pericyst is then cleaned with gauze steeped in povidone iodine. A rubber tube is inserted into the cavity and taken out from the skin under the diaphragm. The edges of the cyst’s fibrous capsule are closed with mattress sutures. The postoperative complication rate is 0.8–4% for intact cysts and 4–6% for ruptured cysts. The most common postoperative complications; prolonged air leak, empyema, and pneumonia due to the aspiration of cystic content or washing solution through an open bronchus adjacent to the cyst.
The mortality rate is lower than1% in intact cysts and around 2% in complicated cysts. Mortality is closely related to the presence of unrecognized cysts in the central nervous system (CNS) or in the proximal part of the pulmonary artery. The size of the cyst is also another fact or that may be associated with an increased complication rate. The CNS and the pulmonary arteries must be evaluated before a surgical attempt is made in every case with disseminated hydatidosis. The recurrence rate is between 1 and 6%. Adherence to the precautions to avoid spreading of the cystic material and the use of albendazole in selected patients decreases the recurrence rate (2,3,4). In literature coexisting liver cysts 105 patients were managed transdiaphragmatically after the lung cysts had been dealt with. Most were in the right lobe of the liver, 69%. Daughter cysts were found 40% cases. Bronchobiliary fistula developed in five patients with a coexisting liver cyst that had been treated by cystotomy and drainage without capitonnage. The fistula was treated successfully by tube drainage followed by open drainage in three patients, and in the remaining two nasoduodenobiliary drainage was performed on the 25th and 34th postoperative days (5). Another literature hydatid disease is endemic villages From 1963 untıl 1982 ,10 patients operated with right thoracotomy, accessıble liver cysts should be excised at the same thoracotomy (6). For the liver cysts located on the dome of the liver (405 patients), they prefer the transthoracic approach: right thoracotomy and phrenotomy (7). According to literature thoracotomy provides better exploration and access to the cyst located in this area when compared with the laparotomy (8). Surgical intervention primary treatment for hydatid disease. Liver cysts located subphrenically can be treated simultaneously with the lung hydatid disease. In patients with coexisting liver cysts, phrenotomy is more convenient and should be applied to prevent a second operation.