Laparoscopic Management of Abdominal Hydatid Disease

Background: Hydatid cysts are a common surgical problem that is encountered in many tropical countries, including Yemen. Open surgical exploration and excision had been the mainstay of treatment until the advent of laparoscopy. Laparoscopic treatment of hydatid disease produces encouraging results, though its feasibility and safety have been questioned. Patients and Methods: Thirteen patients with abdominal hydatid Cysts; 9 hepatic and 4 splenic, underwent laparoscopic surgery between July 2005 and August 2006 in A1 Amal specialized hospital of Hodyedah in Yemen. Full physical examination, laboratory assessment and imaging of the cysts were performed. The main surgical maneuvers include puncture, parasite neuteralization, and complete evacuation of the cyst followed by partial cystectomy in all cases with addition of omentoplasty in seven cases. All patients received a course of albendazole for one month preoperatively and 3 months postoperatively. Results: Twenty three Echinococal cysts in 13 patients were treated laparoscopically. The average cyst diameter was 9.2cm. Twelve cysts located in the left hepatic lobe, 5 in the right lobe, 4 in spleen and 2 in the anterior abdominal wall. Two cysts were calcified with thick wall. Laparoscopic partial cystectomy with drainage was done in 8 patients and Omentoplasty was added to 3 of them. Conversion to open surgery was performed in 5 patients. The average operative time was 118 minutes with no intraoperative complication. The length of hospital stay range from 3 to 17 days with no operative mortality. Follow-up period for 3 up to 9 months during which no recurrences were observed. Conclusion: Laparoscopic treatment of hydatid disease is feasible in selected patients respecting the principles of open surgery and seems beneficial concerning postoperative comfort, hospital stay and return to daily activities.