Standardized endocystectomy technique for surgical treatment of uncomplicated hepatic cystic echinococcosis

• Published in: PLoS neglected tropical diseases Vol. 13; no. 6; p. e0007516
• Main Authors: Al-Saeedi, Mohammed, Khajeh, Elias, Hoffmann, Katrin, Ghamarnejad, Omid, Stojkovic, Marija, Weber, Tim F, Golriz, Mohammad, Strobel, Oliver, Junghanss, Thomas, Büchler, Markus W, Mehrabi, Arianeb
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01-06-2019; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aged; Biology and Life Sciences; Bleeding; Care and treatment; Classification; Cystectomy; Cysts; Diagnosis; Diagnostic imaging; Diagnostic systems; Echinococcosis; Echinococcosis, Hepatic - surgery; Endoscopy - methods; Endoscopy - standards; Female; Fistula; Hospitals; Humans; Imaging techniques; Infectious diseases; Interdisciplinary aspects; Lesions; Liver; Liver diseases; Magnetic resonance imaging; Male; Medicine; Medicine and Health Sciences; Methods; Middle Aged; Morbidity; Mortality; Parasitology; Patient outcomes; Patients; Recurrence; Research and Analysis Methods; Surgery; Surgical outcomes; Survival Analysis; Systematic review; Thoracic surgery; Treatment Outcome; Tropical diseases; Ultrasonic imaging; Young Adult; Germany
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0007516

Two surgical options are available for cystic echinococcosis (CE). The two principal approaches are radical (resection of the cyst) and conservative (evacuation of the cyst content and partial removal of the cyst capsule). Here, we describe a standardized endocystectomy technique for hepatic echinococcosis.
Twenty-one patients (male/female: 4/3; median age: 28 years) with uncomplicated, isolated hepatic CE (cyst stages WHO CE1, 2, 3a, and 3b) that were treated with the standardized endocystectomy described in this paper. Before the operation and during the follow-up period (mean: 33.8 months, median: 24 months), patients underwent clinical and sonographical and/or magnetic resonance imaging assessment during regular visits managed by an interdisciplinary team.
Forty-seven cysts were treated with the standardized endocystectomy technique. The median number of cysts per patient was two (range: 1-8). Nine patients (43%) had a single cystic lesion. The median operation time was 165 minutes and the median intraoperative bleeding volume was 200 mL. The median hospital stay was nine days (range: 6-28 days). Morbidity (Clavien-Dindo III) occurred in four patients (19%). No mortality and no recurrence were found during the median follow-up time of 24 months.
The standardized endocystectomy technique presented is a safe procedure with acceptable morbidity, no mortality, and without recurrences in our patient series. Important components of our CE management are interdisciplinary patient care, adequate diagnostic work-ups, and regular pre- and postoperative visits, including long-term follow-up for early and reliable capture of recurrences.