Minimal invasive surgical method of treatment of liver echinococcosis

Echinococcosis is rather spread parasitic disease all over the world. Morbidity rate of the population of Uzbekistan with this parasite by maintenance inspection data using ultrasound and fluoroscopy is from 6 to 9 among 100 000 population, have not, shown tendency of reduction to date.

Obj ective: The aim of our investigation is to improve surgical outcome of the patients with EL, using minimal invasive surgery and postoperative chemotherapy.

Material and Methods: Since (from 1998 till current days) in the surgical department of the hospital of Samarkand State medical institute has been introduced a video assisted operation. This introduction will be cause change to certain surgical procedures in hydatid disease of liver and lungs. During 1996-1998 years, before introduction video assisted operation 69 patients (32 male and 37– female) with plural EL were operated traditionally by using laparotomic accesses. Echinococcectomy (EE) using minimal invasive surgery has been performed from 2010 to 2012 for 76 patients (36 male and 40-female) with plural EL. In total (n=145) men were 68 (46,9%), women – 77 (53,1%).

Results: Diagnosis by ultrasonography has important place in the detection of the disease. CT examination has been used in 5 (2,7%) cases. After using traditional laparotomic accesses in the surgical treatment 69 patients founded by us the followings: traumatism of approach (more then 22 cm), late activity of patients (24-48

Академический журнал Западной Сибири № 1, 2013

hours after operation), prolonged and frequent anesthetization (3-4 time, during 3-5 days), long hospitalization period (more than 11 days) and cosmetics defects. Postoperative complications such as suppuration of cyst (n=4), cys-tobiliar fistula (n=3), rupture of cysts to biliary tracts (n=2), rupture in abdominal cavity (n=1) were found out in 9 (13,4%) patients. Recurrence of disease exposed in 8 (11,6%) patients.

After introduction video assisted operation different variants of echinococcectomy (EE) were applied to 76 patients depending on size, localization and condition of cysts. Only in 9 (11,8%) patients laparoscopic EE from the liver has been performed. But, in these cases conversion has been performed in 3 (33.3%) patients with transfer to minilaparotomy. 67 (36,2%) patients received of EE from the liver through minilaparotomic approach using “Miniassist” instruments. Technical simplicity of the operation in comparison with pure laparoscopic EE made it possible to use this operation more often. Shortcoming of this method is difficulties performing the operation, with the cysts located on inaccessible segments of the liver. There were no complications in the postoperative period. The patients stay in the hospital after such operations was 5,8±1,4 days. So, single cysts, till 15 cm in diameter, with localization in the II, III, IV, V segments and partially in the VI segment, can be removed through minilaparotomic approach. It should be noted that after minimal invasive surgery activity of patient was in 6-12 hours after operation and they don’t need long (only 1-2 time) and frequent (only 1-2 days) anesthetization.

All patients of this group have undergone the course of chemotherapy (Albendazol 12 mg/kg/day) in the postoperative period (2 or more course) depending on the number, condition and size of cysts. No recurrences have been noticed in the followed-up patients.

Conclusion: Comparative analysis of patients who treated with traditional method and video assisted operation showed that using of minimal invasive surgery in the treatment of EL made it possible to avoid extensive traumatic approaches, to decrease painful syndrome and expenditure of medicines in the postoperative period, to diminish the terms of rehabilitation of patients, to receive a good cosmetic effect. Application of these interferences excludes opportunity of development of postoperative hernias, ligature fistulas, rough deforming cicatrexes and commissure disease of the abdominal cavity.