Background: Resectional procedures for hydatid cyst are associated with decreased cavity related complications and recurrence rate. In contrast to laparoscopic drainage procedures, the evidence for laparoscopic resection of hydatid cyst is limited in the literature.
Methods: A retrospective analysis of a prospectively maintained database of patients with hydatid cyst managed between January 2006 and December 2011. Patients planned for laparoscopic resectional surgery for hydatid cyst were included in the analysis. Clinical features, cyst location, size, type of cyst, operative parameters, reasons for conversion and postoperative recurrence rate were analysed.
Results: Of the 56 patients with hydatid cyst managed surgically during the study period, 35 patients underwent resectional procedures. Fourteen patients planned for the laparoscopic resectional procedure were included in the analysis. Abdominal pain was the most common presenting symptom and the majority (10/14) had Gharbi type II/III cyst. Laparoscopic cystopericystectomy (n=5) was the commonly performed procedure followed by laparoscopic left lateral hepatectomy (n=4). The mean (range) intra-operative blood loss and the mean (range) operating time was 111.1 (50-250) mL and 243.3 (180-300) minutes respectively. Five patients required conversion to open surgery in view of bleeding or posterosuperior location of the cyst. None of the patients had intra-operative spillage of cyst contents. At a median (range) follow-up of 54 (21-86) months, none of the patients had a local or extrahepatic recurrence.
Conclusions: Laparoscopic resectional procedure for hydatid cyst of the liver is technically feasible with excellent perioperative and long-term outcomes. Inability to perform a laparoscopic resectional procedure should not be used as an argument to perform laparoscopic drainage.