Hydatid liver surgery very important surgery in the middle east because high incidence cases in this area
This is a broad question open with variety of presentations from unilocular to multilocular, single to multiple cysts including those almost replacing the liver parenchyma. Following management protocol can be tried briefly:
1. An oral administration of Albendazole 10 mg/kg/day for 6-8 wks and reassess by US examn. Locally drainage under USG guidance, injecting hypertonic saline or alcohol or sclderosant, etc can be tried. Failing these lesser invasive techniques, laparoscopic exploration of cyst with either deroofing and aspiration and saline washing of cyst and adjacent peritoneal cavity, etc. If a cystr is located in left lobe of liver, partial hepatic local excision is very easily carried out.
Post-op, continue Albendazole doses for another six to deight months. It should be of help enough.
Accordingly , it depends on several factors, like size, site , patients age , nature of the cyst, the options include cyst removal, with endocyst, deroofing, liver resection?, and so on
Agreed with above criteria ,but we follow is a course of Albendazole(all our patients were already on Albendazole by their physician) and plan for laparoscopic deroofinging and omentopexy,rarly we did left lobe resection.Prior to the introduction of laparoscopy standard open.I donot have experience with U/S s guided drainage.All patients had post op Albendazole.
Least morbidity and good results.
Once I had a patient with left lobe of liver replaced with cyst. There were no other lesion in rest of the liver. Left triangular ligament of liver was divided which completely mobilised the entire lobe. Then 9" long clamps were placed proximal to the cyst and the liver was divided serially till entire lobe was resected. These clamps were released following transfixation ligatures with 1/0 Chromic catgut and post-op, patent did well. It also helped to limit the length of course of post-op Albendazole to few weeks only. As happens, patient never returned back for follow-up. I imagined that no news is a good news. I would imazine, such lesions must be very rare. I am one lucky surgeon to have witnessed it. Another lesion was limited to a big cyst in posterior part of neck.
PAIR - Percutaneous aspiration, instillation of hypertonic saline and reaspiration
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