Laparoscopic Versus Conventional Surgery for Hepatic Hydatid Disease: A Comparative Study

Abstract

Background: laparoscopic treatment of hepatic hydatid disease has undergone revolution in parallel to progress in laparoscopic surgery. Controversiesabouttherolelaparoscopyinthemanagementof liverhydatidcysthavenotbeenresolvedbecauseof scarce experience worldwide. Objectives: The aim of our study was to compare surgical outcome of laparoscopic approach with open surgery for the management of hepatic hydatid disease. Methods: It was a retrospective and prospective study conducted in the department of surgery SKIMS Srinagar over a period of eight years from January 2008 to January 2016 in Sheri Kashmir institute of medical sciences Srinagar India, Srinagar. The study included all the adult patients admitted with a diagnosis of hepatic hydatid disease and the total number of patients studied was 80. All patients were pre-operatively and post- operatively treated with Albendazole. The patients were alternately taken either for laparoscopic approach or for open approach. For data that was included retrospectively patients were enrolled in either groups based upon the type of surgery they had undergone. Patients were followed for any recurrence for a period ranging from one year to six years with an average follow up period of 24 months. All the data was entered in detailed proforma and analysed. Results: Mean age of presentation was 40.27 years in open group and 38.80 years for laparoscopic group. Majority of patients (55%) presented with pain abdomen. Mean operative time was 60.43 minutes in open group and 89.80 min. for laparoscopic group. Two patients (5%) from the laparoscopic group had to be converted to open. In laparoscopic group mean hospital stay was 3.40 days whileinopengroupitwas8.73days. Meantimetoreturntoworkwas8.10daysinlaparoscopicgroupand20.70daysinopengroup. In laparoscopic group none of the patients had surgical site infection while as in open group 4 (10%) had surgical site infection. In laparoscopicgroup,biliaryleakwasseenin3(7.5%)patients,whileinopengroupitwasseenin2(5%)patients. Recurrencewasseen in2(5%)patientswhounderwentopensurgery,whileasrecurrencewasnotseeninanyof thepatientswhounderwentlaparoscopic surgery. Conclusions: Based on our encouraging results from our current study, we conclude that laparoscopic hydatid surgery is safe and feasible for selected patients in which criteria is met, motivated primarily by lower post-operative morbidity, mortality and recurrence. there was no recurrence in laparoscopic group while as in open group 5% had recurrence. Lower recurrence in our study was attributed to use of Albenda-zolepreandpostoperativelyinpatientsof hepatichydatid cysts. Variousstudies(17)haveshownzerorecurrencerates in patients treated with Albendazole pre and post operatively.