Laparoscopic management of hydatid cysts using long ribbon gauze: An initial experience of 37 consecutive cases

Objective

The laparoscopic approach is becoming the standard of care for many surgical disorders. However, in the case of hydatid cysts, laparoscopic management is challenging due to the risk of spillage of hydatid fluid, which can cause an anaphylactic reaction and recurrence. Here, we report our initial experience with laparoscopic partial pericystectomy of hydatid cysts using long ribbon gauze to decrease intra-operative spillage.

Method

This was a retrospective study (between January 2010 and December 2021) in the Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Science, a tertiary care referral center in northern India. Here, we have included 37 consecutive patients with hydatid cysts of the liver and spleen. Diagnosis was made by laboratory and imaging findings (abdominal sonography or contrast enhanced CT scans). All patients were managed with laparoscopic partial pericystectomy. Intraoperatively, a betadine-soaked long ribbon gauze, high-pressure suction canula, and an endo-bag were used in all patients. The collected data included patient demography, location, size, and number of cysts, WHO type, operative time, blood loss, postoperative complications, hospital stay and follow-up.

Result

In our series, the mean age was 38.4 ± 13.6 years, 15 (40.5%) were men and 22 (59.5%) were women. The right lobe of the liver was the most commonly affected site (21, 56.8%). The mean operative time was 80.0 ± 32.0 min, and intraoperative blood loss was 23.6 ± 11.5 mL. Bile leak was present in 6 (16.2%) patients. There was no mortality. The hospital stay was 5 (3, 9) days, and no recurrence was observed at a median follow-up of 36 months.

Conclusion

Laparoscopic partial pericystectomy using this technique is safe in the management of hydatid cysts. Simply, proper packing and safe removal of soaked gauzes can minimize the incidence of postoperative complications and recurrence.